IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of penicillins, monobactams, and carbapenems.
Open accessAbstract
Background There have been few studies regarding the cross-reactivity and tolerability of penicillins, aztreonam, and carbapenems in large samples of subjects with cephalosporin allergy.Objective We sought to evaluate the possibility of using penicillins, monobactams, and carbapenems in subjects with cephalosporin allergy who especially require them.Methods We conducted a prospective study of 98 consecutive subjects who had 106 immediate reactions (mostly anaphylactic shock) to cephalosporins and had positive skin test results for these drugs. To assess the cross-reactivity with penicillins, monobactams, and carbapenems and the tolerability of such alternative β-lactams, all subjects underwent skin tests and serum-specific IgE assays with penicillin reagents, as well as skin tests with aztreonam, imipenem/cilastatin, and meropenem. Subjects with negative test results were challenged with meropenem, imipenem/cilastatin, aztreonam, and amoxicillin.Results Positive allergologic test results to penicillins were displayed by 25 (25.5%) subjects, including 1 with positive results to all reagents tested and another with a positive result to aztreonam. Another subject had positive results to both ceftazidime and aztreonam. A reaction to cephalosporins with side-chain structures similar or identical to those of penicillins was a significant predictor of cross-reactivity because of an increased 3-fold risk of positive results on allergologic tests with penicillin determinants. Challenges with alternative β-lactams were tolerated, with the exception of 1 urticarial reaction to imipenem/cilastatin.Conclusions About 25% of subjects with cephalosporin allergy had positive results to penicillins, 3.1% to aztreonam, 2% to imipenem/cilastatin, and 1% to meropenem. In those who especially require alternative β-lactams, pretreatment skin tests are advisable because negative results indicate tolerability of the β-lactam concerned.
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Allergic reactions with third-generation cephalosporins (e.g., ceftriaxone) are uncommon among persons with a history of penicillin allergy.
“Allergic reactions with third-generation cephalosporins (e.g., ceftriaxone) are uncommon among persons with a history of penicillin allergy (620,631,658,896).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [896]
The Discussion (page unavailable) reports that only 5 of 128 subjects with penicillin allergy in an earlier study had positive skin tests to a group of cephalosporins including ceftriaxone. It also says that patients with negative skin tests tolerated cephalosporin challenges. This supports low cross-reactivity, but it does not establish the rate of allergic reactions to third-generation cephalosporins among all people with a history of penicillin allergy; the present study enrolled patients with cephalosporin allergy and no history of penicillin reactions. (LLM, conf=0.84)
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- Authors
- Romano, A., Gaeta, F., Valluzzi, R. L., Caruso, C., Rumi, G., & Bousquet, P. J.
- Affiliations
- Oasi Maria SS (IT)
- Hôpital Arnaud de Villeneuve (FR)
- Corresponding author
- Romano, Antonino
- ORCID
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2010-11
- Volume
- 126
- Issue
- 5
- Pages
- 994-999
- ISSN
- 0091-6749 (ISSN-L)
- OpenAlex
- W2158847388
- Cited by
- 162
- References
- 48
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 3 · 2022: 7 · 2021: 6 · 2020: 17 · 2019: 13 · 2018: 13 · 2017: 17 · 2016: 9 · 2015: 11 · 2014: 16 · 2013: 15 · 2012: 8
- FWCI
- 8.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- cephalosporin allergy, IgE-mediated hypersensitivity, cross-reactivity, penicillin, monobactams, carbapenems, aztreonam, imipenem/cilastatin, meropenem, skin testing, drug tolerance, anaphylaxis, side chain structure
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cephalosporins, Cross Reactions, Drug Hypersensitivity, Female, Humans, Hypersensitivity, Immediate, Immunoglobulin E, Male, Middle Aged, Monobactams, Penicillins, Skin Tests, Carbapenems, Young Adult
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