Cross-reactivity between penicillins and cephalosporins: clinical and immunologic studies.
Nineteen well-characterized penicillin-allergic patients were investigated for their sensitivity to cephalosporins containing potentially cross-reactive side chains. All patients were administered cephamandole parenterally and, if this was tolerated, a course of oral cephaloridine was administered. Only two patients responded to the cephamandole; none of the remaining patients reacted to cephaloridine. Benzylpenicilloyl RAST-inhibition studies with sera from three subjects who had not reacted to the cephalosporins demonstrated that cephamandole linked to proteins was capable of recognizing benzylpenicilloyl-specific IgE antibody. It is concluded that consideration of side chain structures can help to predict possible cross-reactions between penicillins and cephalosporins, but carefully controlled challenge tests are advisable before penicillin-allergic patients are treated with cephalosporins. In relation to cross-reacting potential, in vitro experimental studies are difficult to interpret and may in some circumstances overestimate the risk.
Blanca
M
M
Allergy Section, Carlos Haya Hospital, Malaga, Spain.
Fernandez
J
J
Miranda
A
A
Terrados
S
S
Torres
M J
MJ
Vega
J M
JM
Avila
M J
MJ
Perez
E
E
Garcia
J J
JJ
Suau
R
R
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D000667:Ampicillin / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D001667:Binding, Competitive; D002511:Cephalosporins / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000276:immunology; D005260:Female; D006801:Humans; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D010406:Penicillins / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D011852:Radioallergosorbent Test
D002511:Cephalosporins; D010406:Penicillins; D000667:Ampicillin; D000658:Amoxicillin; D010400:Penicillin G