![]() Cross-reactivity and tolerability of cephalosporins in patients with immediate hypersensitivity to penicillins. Romano A, Guéant-Rodriguez RM, Viola M, Pettinato R, Guéant JL. Diagnostic evaluation of a large group of patients with immediate allergy to penicillins: the role of skin testing. Torres MJ, Romano A, Mayorga C, Moya MC, Guzman AE, Reche M, et al. Lack of allergic cross-reactivity to cephalosporins among patients allergic to penicillins. Novalbos A, Sastre J, Cuesta J, De Las Heras M, Lluch-Bernal M, Bombín C, et al. Immediate allergic reactions to cephalosporins: cross-reactivity and selective responses. Romano A, Mayorga C, Torres MJ, Artesani MC, Suau R, Sánchez F, et al. Cephalosporin allergy: characterization of unique and cross-reacting cephalosporin antigens. Romano A, Quaratino D, Aimone-Gastin I, Mayorga C, Papa G, Venuti A, et al. Cross-reactivity between a penicillin and a cephalosporin with the same side chain. Miranda A, Blanca M, Vega JM, Moreno F, Carmona MJ, García JJ, et al. Clinical cross-reactivity between amoxicillin and cephadroxil in patients allergic to amoxicillin and with good tolerance of penicillin. Sastre J, Quijano LD, Novalbos A, Hernandez G, Cuesta J, de las Heras M, et al. Allergic reactions to betalactams: studies in a group of patients allergic to penicillin and evaluation of cross-reactivity with cephalosporin. 1991 46:196–202.Īudicana M, Bernaola G, Urrutia I, Echechipia S, Gastaminza G, Muñoz D, et al. Tolerance to aztreonam in patients allergic to beta-lactam antibiotics. Vega JM, Blanca M, García JJ, Miranda A, Carmona MJ, García A, et al. Cross-reactivity between penicillins and cephalosporins: clinical and immunologic studies. 2011 127 Suppl 3:S67–73.īlanca M, Fernandez J, Miranda A, Terrados S, Torres MJ, Vega JM, et al. Diagnosis and management of drug hypersensitivity reactions. Romano A, Torres MJ, Castells M, Sanz ML, Blanca M. Management of allergy to penicillins and other beta-lactams. Standards of care committee of the British society for allergy and clinical immunology. Mirakian R, Leech SC, Krishna MT, Richter AG, Huber PA, Farooque S, et al. This review provides detailed and useful information on structural similarities among side-chain determinants of penicillins and cephalosporins. The complex clinical picture of beta-lactam hypersensitivity: penicillins, cephalosporins, monobactams, carbapenems, and clavams. Papers of particular interest, published recently, have been highlighted as: Some studies concerning cross-reactivity among BLs have found patterns of allergy-test positivity which cannot be explained by either the common BL ring or by similar or identical side chains, thus indicating the possibility of coexisting sensitivities to different BLs because of prior exposures to them. The cross-reactivity related to the selective recognition of the BL ring by IgE or T lymphocytes, which entails positive responses to all BLs tested, appears to be exceptional. With regard to subjects with an IgE-mediated hypersensitivity to cephalosporins, in a single study, about 25 % of the 98 subjects with such hypersensitivity had positive results to penicillins, 3 % to aztreonam, 2 % to imipenem/cilastatin, and 1 % to meropenem. In these subjects, a few prospective studies have demonstrated a rate of cross-reactivity between penicillins and both carbapenems and aztreonam lower than 1 %. Specifically, in penicillin-allergic subjects, cross-reactivity between penicillins and cephalosporins may exceed 30 % when they are administered cephalosporins with identical side chains to those of responsible penicillins. In subjects with either IgE-mediated or T-cell-mediated hypersensitivity, cross-reactivity among BLs, particularly among penicillins and among cephalosporins, as well as between penicillins and cephalosporins, seems to be mainly related to structural similarities among their side-chain determinants. This review takes into account mainly the prospective studies which evaluated cross-reactivity among BLs in subjects with a well-demonstrated hypersensitivity to a certain class of BLs by performing allergy tests with alternative BLs and, in case of negative results, administering them. ![]() Monobactams, carbapenems, oxacephems, and beta-lactamase inhibitors constitute the four minor classes of BLs. Penicillins and cephalosporins are the major classes of beta-lactam (BL) antibiotics in use today and one of the most frequent causes of hypersensitivity reactions to drugs. ![]()
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