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Diagnosis and management of immediate hypersensitivity reactions to cephalosporins.

Kim MH, Lee JM - Allergy Asthma Immunol Res (2014)

Bottom Line: In vitro tests are in development using recent technological advances and can be used as complementary tests.However, they are not commonly used because of their reduced sensitivity and limited availability.In selected cases of inconclusive results in both skin tests and IgE assays, a graded challenge or induction of drug tolerance with the implicated cephalosporin should be performed.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
Cephalosporins can cause a range of hypersensitivity reactions, including IgE-mediated, immediate reactions. Cephalosporin allergy has been reported with use of a specific cephalosporin, as a cross-reaction between different cephalosporins or as a cross-reaction to other β-lactam antibiotics. Unlike penicillins, the exact allergenic determinants of cephalosporins are less well understood and thus, standardized diagnostic skin testing is not available. Nevertheless, skin testing with diluted solutions of cephalosporins can be valuable in confirming IgE-mediated hypersensitivity reactions. In vitro tests are in development using recent technological advances and can be used as complementary tests. However, they are not commonly used because of their reduced sensitivity and limited availability. In selected cases of inconclusive results in both skin tests and IgE assays, a graded challenge or induction of drug tolerance with the implicated cephalosporin should be performed.

No MeSH data available.


Related in: MedlinePlus

Use of a cephalosporin in patients with penicillin allergy.
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Figure 2: Use of a cephalosporin in patients with penicillin allergy.

Mentions: Penicillin skin testing can help guide physicians in their approach to patients with a history of penicillin allergy that requires treatment with cephalosporins (Fig. 2). Patients who have negative results in penicillin skin testing are at no greater risk of an allergic reaction and can safely receive cephalosporins.4 This group may include the vast majority of individuals labeled penicillin allergic.71,72 On the other hand, administration of cephalosporins to patients who have positive results in penicillin skin testing should be approached more cautiously. If possible, such patients should be skin-tested with a non-irritating concentration of the cephalosporin before treatment.34 Patients who have positive results in cephalosporin skin testing should be either not treated with the cephalosporin or desensitized if alternative drugs are not available.7 Because the negative predictive value of cephalosporin skin testing is not known, the cephalosporin should be administrated by a graded challenge in patients who showed positive results to penicillin and negative results to cephalosporin in skin testing.4,7 When patients with a history of penicillin allergy are given a cephalosporin directly without penicillin skin testing, the chance of reacting to the cephalosporin is <1%.7,23 However, since cases of fatal anaphylaxis have been reported following cephalosporin administration, a graded challenge should be strongly considered.64,88,89


Diagnosis and management of immediate hypersensitivity reactions to cephalosporins.

Kim MH, Lee JM - Allergy Asthma Immunol Res (2014)

Use of a cephalosporin in patients with penicillin allergy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214968&req=5

Figure 2: Use of a cephalosporin in patients with penicillin allergy.
Mentions: Penicillin skin testing can help guide physicians in their approach to patients with a history of penicillin allergy that requires treatment with cephalosporins (Fig. 2). Patients who have negative results in penicillin skin testing are at no greater risk of an allergic reaction and can safely receive cephalosporins.4 This group may include the vast majority of individuals labeled penicillin allergic.71,72 On the other hand, administration of cephalosporins to patients who have positive results in penicillin skin testing should be approached more cautiously. If possible, such patients should be skin-tested with a non-irritating concentration of the cephalosporin before treatment.34 Patients who have positive results in cephalosporin skin testing should be either not treated with the cephalosporin or desensitized if alternative drugs are not available.7 Because the negative predictive value of cephalosporin skin testing is not known, the cephalosporin should be administrated by a graded challenge in patients who showed positive results to penicillin and negative results to cephalosporin in skin testing.4,7 When patients with a history of penicillin allergy are given a cephalosporin directly without penicillin skin testing, the chance of reacting to the cephalosporin is <1%.7,23 However, since cases of fatal anaphylaxis have been reported following cephalosporin administration, a graded challenge should be strongly considered.64,88,89

Bottom Line: In vitro tests are in development using recent technological advances and can be used as complementary tests.However, they are not commonly used because of their reduced sensitivity and limited availability.In selected cases of inconclusive results in both skin tests and IgE assays, a graded challenge or induction of drug tolerance with the implicated cephalosporin should be performed.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
Cephalosporins can cause a range of hypersensitivity reactions, including IgE-mediated, immediate reactions. Cephalosporin allergy has been reported with use of a specific cephalosporin, as a cross-reaction between different cephalosporins or as a cross-reaction to other β-lactam antibiotics. Unlike penicillins, the exact allergenic determinants of cephalosporins are less well understood and thus, standardized diagnostic skin testing is not available. Nevertheless, skin testing with diluted solutions of cephalosporins can be valuable in confirming IgE-mediated hypersensitivity reactions. In vitro tests are in development using recent technological advances and can be used as complementary tests. However, they are not commonly used because of their reduced sensitivity and limited availability. In selected cases of inconclusive results in both skin tests and IgE assays, a graded challenge or induction of drug tolerance with the implicated cephalosporin should be performed.

No MeSH data available.


Related in: MedlinePlus