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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 penicillin in patients with cephalosporin allergy. Penicillin skin testing should include both major (Pre-Pen) and minor determinant reagents (MDM). When these reagents are not available, it is advisable to select a penicillin that have a dissimilar side chain to the culprit cephalosporin, and skin testing with that penicillin in its native form. If the results are negative, the patient may be treated with a graded challenge to the penicillin.
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Figure 3: Use of penicillin in patients with cephalosporin allergy. Penicillin skin testing should include both major (Pre-Pen) and minor determinant reagents (MDM). When these reagents are not available, it is advisable to select a penicillin that have a dissimilar side chain to the culprit cephalosporin, and skin testing with that penicillin in its native form. If the results are negative, the patient may be treated with a graded challenge to the penicillin.

Mentions: Most patients with immediate reactions to cephalosporins and no history of reacting to penicillins, will tolerate penicillins. However, some patients react to both groups of drugs. Therefore, skin testing with the penicillin reagent is indicated in such patients to guide management (Fig. 3).90 Negative results in penicillin skin testing indicate that the patient's reaction to the cephalosporin was probably due to a unique cephalosporin determinant. Therefore, the patient is not at increased risk for reacting to a penicillin, provided that the penicillin does not share a side chain with the culprit cephalosporin.6 Positive results indicate that the patient may be reactive to the β-lactam core structure or side chains that are shared by the penicillin and the culprit cephalosporin. The patient may be treated with a non-β-lactam antibiotic or desensitized to the desired penicillin. If penicillin skin testing is not available, it is advisable to select a penicillin that does not have a similar side chain to that of the culprit cephalosporin, and to perform skin testing with that penicillin in its native form. If the results are negative, the patient may be treated with a graded challenge to the penicillin.


Diagnosis and management of immediate hypersensitivity reactions to cephalosporins.

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

Use of penicillin in patients with cephalosporin allergy. Penicillin skin testing should include both major (Pre-Pen) and minor determinant reagents (MDM). When these reagents are not available, it is advisable to select a penicillin that have a dissimilar side chain to the culprit cephalosporin, and skin testing with that penicillin in its native form. If the results are negative, the patient may be treated with a graded challenge to the penicillin.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Use of penicillin in patients with cephalosporin allergy. Penicillin skin testing should include both major (Pre-Pen) and minor determinant reagents (MDM). When these reagents are not available, it is advisable to select a penicillin that have a dissimilar side chain to the culprit cephalosporin, and skin testing with that penicillin in its native form. If the results are negative, the patient may be treated with a graded challenge to the penicillin.
Mentions: Most patients with immediate reactions to cephalosporins and no history of reacting to penicillins, will tolerate penicillins. However, some patients react to both groups of drugs. Therefore, skin testing with the penicillin reagent is indicated in such patients to guide management (Fig. 3).90 Negative results in penicillin skin testing indicate that the patient's reaction to the cephalosporin was probably due to a unique cephalosporin determinant. Therefore, the patient is not at increased risk for reacting to a penicillin, provided that the penicillin does not share a side chain with the culprit cephalosporin.6 Positive results indicate that the patient may be reactive to the β-lactam core structure or side chains that are shared by the penicillin and the culprit cephalosporin. The patient may be treated with a non-β-lactam antibiotic or desensitized to the desired penicillin. If penicillin skin testing is not available, it is advisable to select a penicillin that does not have a similar side chain to that of the culprit cephalosporin, and to perform skin testing with that penicillin in its native form. If the results are negative, the patient may be treated with a graded challenge to the penicillin.

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