Cross-Reactivity to Penicillin Quite Likely With Cephalosporin Hypersens... (print...

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From Reuters Health Information

Cross-Reactivity to Penicillin Quite Likely With
Cephalosporin Hypersensitivity
NEW YORK (Reuters Health) Oct 12 - There's a 25% chance that patients with hypersensitivity to
cephalosporins will also react to penicillins, a European group reports, but the risk with other beta-lactams is
much smaller.

However, the researchers advise pretreatment skin testing in these situations, in their report in the October 1
online issue of the Journal of Allergy and Clinical Immunology.

Dr. Antonino Romano with the Complesso Integrato Columbus in Rome, Italy, and colleagues point out that
several studies have looked at cross-reactivity to cephalosporins in patients with penicillin hypersensitivity, but
detailed information about the reverse is patchy.

"We conducted a prospective study to evaluate the possibility of giving penicillins, monobactams, and
carbapenems to patients with documented cephalosporin allergy who especially require these treatments," the
authors explain.

To that end, they studied 98 consecutive patients who had had immediate reactions to cephalosporins. All the
subjects underwent skin testing with penicillin reagents, aztreonam, imipenem/cilastatin, and meropenem, as
well as serum IgE assays specific for penicillin. Those with negative results underwent confirmatory challenges.

Combining the results of skin tests and specific IgE assays with the penicillin reagents, 25 (25.5%) subjects had
positive results to these reagents, the investigators found. Three (3.1%) had positive responses to aztreonam,
two (2%) to imipenem/cilastatin, and one (1%) to meropenem.

Looked at another way, 72 (73.5%) patients had negative test results, including challenges, with all beta-lactams
other than cephalosporins.

Dr. Romano and colleagues conclude that their results support recommendations on the management of
patients with cephalosporin reactions who require a penicillin: skin test first and if negative, treat; if positive, use
an alternative antibiotic or undertake penicillin desensitization.

"On the other hand, our data indicate a very low rate of cross-reactivity between cephalosporins and both
aztreonam and carbapenems," they write. "Therefore the practice of avoiding the latter in patients with
cephalosporin allergy should be reconsidered."

J Allergy Clin Immunol. Posted online October 1, 2010.Abstract

Reuters Health Information © 2010

http://www.medscape.com/viewarticle/730291_print 22/10/2010