title: A statement on cefazolin immediate hypersensitivity: data from a large database, and focus on the cross-reactivities.
abstract: BACKGROUND
  More perioperative cefazolin use has resulted in an increased risk of cefazolin-associated reactions.
  
  
  OBJECTIVE
  The aim of this article is to study immediate reactions to cefazolin and attempt to determine possible allergic cross-reactivity with other ß-lactams using data from the Drug Allergy and Hypersensitivity Database (DAHD).
  
  
  METHODS
  All 25 cefazolin-associated reactions in the DAHD were reviewed. The cases identified were then investigated according to the European Network for Drug Allergy (ENDA) recommendations by skin testing and challenges.
  
  
  RESULTS
  A total of 10 individuals with proven IgE-mediated cefazolin hypersensitivity were identified between January 1999 and July 2009. All the index reactions were compatible with an acute IgE-mediated process, six with anaphylaxis, two with systemic allergic reactions without hypotension, and two with urticaria/angioedema. Cefazolin skin tests were positive in seven individuals and cefazolin challenges were positive in three more individuals. In the eight cefazolin allergic patients who had challenges with other ß-lactams, there was no positive reaction noted.
  
  
  CONCLUSIONS
  In this cohort of patients with IgE-mediated reactions to cefazolin, a majority tolerated amoxicillin and several patients tolerated other cephalosporins. This implies that the R1 side-chain may play an essential role in IgE-mediated reactions to cefazolin. No clear rule to predict cross-reactivity with other ß-lactams could be determined. More research on IgE-mediated hypersensitivity to cefazolin and other cephalosporins is needed.
authors.affiliation: INSERM U 915, L'institut du thorax, Nantes, France. anais.pipet@chunantes.fr
authors.forename: A
authors.initials: A
authors.lastname: Pipet
authors.forename: G
authors.initials: G
authors.lastname: Veyrac
authors.forename: F
authors.initials: F
authors.lastname: Wessel
authors.forename: P
authors.initials: P
authors.lastname: Jolliet
authors.forename: A
authors.initials: A
authors.lastname: Magnan
authors.forename: P
authors.initials: P
authors.lastname: Demoly
authors.forename: P J
authors.initials: PJ
authors.lastname: Bousquet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000737:chemistry / Q000276:immunology*; D002437:Cefazolin / Q000737:chemistry / Q000276:immunology*; D002648:Child; D003429:Cross Reactions / Q000276:immunology; D016208:Databases, Factual; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology*; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin