Anaphylactic shock associated with cefuroxime axetil: structure-activity relationships.
OBJECTIVE
To present a predictive model of allergenicity based on a structure-activity relationship analysis of beta-lactam antibiotics using appropriate skin testing procedures.


METHODS
A 39-year-old woman was diagnosed with anaphylactic shock a few minutes after taking a 500 mg tablet cefuroxime of axetil and was admitted to the emergency department with dizziness, facial angioedema, generalized skin rash, and inferior cardiac ischemia. Skin testing confirmed the involvement of cefuroxime as the cause of the anaphylactic reaction, and the reaction was defined as probable according to the Naranjo probability scale. We then performed skin testing to study cross-reactivity between different beta-lactam antibiotics. In addition to this initial assessment, a structure-activity relationship (SAR) analysis was done. It showed that the patient was sensitized to beta-lactam antibiotics presenting a methoxyimino group, but not to similar compounds lacking this chemical group (eg, amoxicillin or penicillin G or V). Challenge with amoxicillin under intensive medical monitoring was tolerated up to a cumulated dose of 1 g, administered intravenously over 2 hours.


CONCLUSIONS
This study demonstrates that SAR analysis could be useful to predict potential adverse reactions to related antibiotics and to select alternative strategies when antibiotic administration is essential.


CONCLUSIONS
An SAR-based approach could help physicians and pharmacists provide allergic patients with relevant advice and propose viable alternatives regarding drug therapy.
Hasdenteufel
Frédéric
F
EA 3999 maladies allergiques: diagnostic et thérapeutique, Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital of Nancy, Nancy, France.
Luyasu
Samuel
S
Renaudin
Jean-Marie
JM
Trechot
Philippe
P
Kanny
Gisèle
G
D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002444:Cefuroxime / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000737:chemistry; D003429:Cross Reactions; D005260:Female; D006801:Humans; D012882:Skin Tests; D013329:Structure-Activity Relationship
D000900:Anti-Bacterial Agents; D002444:Cefuroxime; C040738:cefuroxime axetil