Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis.

Pichichero, Michael E.; Casey, Janet R.

doi:10.1016/j.otohns.2006.10.007

Cited by 184Drug-Induced Adverse ReactionsPharmacovigilance and Adverse Drug ReactionsSurgical site infection prevention

Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis.

Pichichero, Michael E., Casey, Janet R.·2007·Otolaryngology–Head and Neck Surgery

DOI 10.1016/j.otohns.2006.10.007

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Abstract

BACKGROUND: Recent analysis of clinical data and a clearer understanding of the role of chemical structure in the development of cross-reactivity indicate that the increased risk of an allergic reaction to a cephalosporin in penicillin-allergic patients is smaller than previously postulated. METHOD: Medline and EMBASE databases were searched with the keywords: cephalosporin, penicillin, allergy, and cross-sensitivity for the years 1960 through 2005. Among 219 articles retrieved, 9 served as source material for this evidence-based meta-analysis. RESULTS: A significant increase in allergic reactions to cephalothin (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.1 to 5.5), cephaloridine (OR = 8.7; CI = 5.9 to 12.8), and cephalexin (OR = 5.8; CI = 3.6 to 9.2), and all first generation cephalosporins plus cefamandole (OR = 4.8; CI = 3.7 to 6.2) were observed in penicillin allergic patients; no increase was observed with second generation cephalosporins (OR = 1.1; CI, 0.6 to 2.1) or third generation cephalosporins (OR = 0.5; CI = 0.2 to 1.1). Clinical challenges, skin testing, and monoclonal antibody studies point to the paramount importance of similarities in side chain structure to predict cross-allergy between cephalosporins and penicillins. CONCLUSION: First-generation cephalosporins have cross-allergy with penicillins, but cross-allergy is negligible with second- and third-generation cephalosporins. Particular emphasis should be placed on the role of chemical structure in determining the risk of cross-reactivity between specific agents.

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The risk for penicillin cross-reactivity between third-generation cephalosporins is negligible.
“the risk for penicillin cross-reactivity between third-generation cephalosporins is negligible (618–621)”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [621]
Cross-sensitivity between ceftriaxone and penicillin can occur.
“Cross-sensitivity between ceftriaxone and penicillin can occur”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [621]

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Cephalosporin use in treatment of patients with penicillin allergies
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Authors: Pichichero, M. E., & Casey, J. R.
Affiliations: University of Rochester Medicine (US)
Corresponding author: Pichichero, Michael E.
ORCID: Pichichero, Michael E.
Venue: Otolaryngology–Head and Neck Surgery
Publisher: Wiley
Published: 2007-03
Volume: 136
Issue: 3
Pages: 340-347
ISSN: 0161-6439 (ISSN-L)
0194-5998
1097-6817
DOI: 10.1016/j.otohns.2006.10.007
OpenAlex: W1987507920
Cited by: 184
References: 48
Citations by year: 2026: 3 · 2025: 8 · 2024: 8 · 2023: 9 · 2022: 10 · 2021: 8 · 2020: 7 · 2019: 13 · 2018: 11 · 2017: 9 · 2016: 7 · 2015: 21 · 2014: 13 · 2013: 12 · 2012: 4
FWCI: 1.01
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 3365 d)
Locations: Otolaryngology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Health Sciences › Medicine › Surgery › Surgical site infection prevention
Keywords: cephalosporins, penicillin allergy, cross-reactivity, drug hypersensitivity, cephalothin, cephaloridine, cephalexin, cefamandole, first-generation cephalosporins, second-generation cephalosporins, third-generation cephalosporins, side chain structure, skin testing, monoclonal antibodies
MeSH terms: Anti-Bacterial Agents, Antibodies, Monoclonal, Cefamandole, Cephalexin, Cephaloridine, Cephalosporins, Cross Reactions, Drug Hypersensitivity, Humans, Immunoglobulin E, Penicillins, Safety, Evidence-Based Medicine

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Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis.

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