title: Beta-lactam hypersensitivity and cross-reactivity.
abstract: Penicillin is the most frequently reported cause of drug allergy, and cross-reactivity of penicillins with other beta-lactam antibiotics is an area of debate. This review evaluates the available data on immunoglobulin E-mediated penicillin hypersensitivity and cross-reactivity with cephalosporin, carbapenem, and monobactam antibiotics. A MEDLINE search was conducted from 1950 to October 2013, and selected references from review articles were also evaluated. There is a wide variety in reported incidences of cross-reactivity between penicillins and cephalosporins or carbapenems, with early retrospective studies suggesting up to 41.7% and 47.4% cross-reactivity, respectively. Conversely, the use of monobactam antibiotics is frequently employed in the case of a penicillin allergy, as prescribers believe that there is no cross-reactivity between the 2 drug classes. More recent prospective studies suggest that the rates of cross-reactivity with cephalosporins and carbapenems are <5% and <1%, respectively. Similarities in penicillin and cephalosporin side chains may play a role in cross-reactivity between these classes. Cross-reactivity with monobactams is essentially negligible; however, there are some clinical data to support an interaction between ceftazidime and aztreonam, due to the similarity of their side chains. The data reviewed suggest that avoidance of other beta-lactams in patients with type 1 hypersensitivity to penicillins should be reconsidered.
authors.affiliation: Post-Graduate Year 2 Infectious Diseases Pharmacotherapy Resident, Temple University Hospital, Philadelphia, PA, USA.
authors.forename: Adrienne T
authors.initials: AT
authors.lastname: Terico
authors.affiliation: Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA jason.gallagher@temple.edu.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Gallagher
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D015780:Carbapenems / Q000009:adverse effects*; D002511:Cephalosporins / Q000009:adverse effects*; D003429:Cross Reactions; D004342:Drug Hypersensitivity; D006801:Humans; D008997:Monobactams / Q000009:adverse effects*; D010406:Penicillins / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D008997:Monobactams; D010406:Penicillins
keywords: beta-lactam; cross-reactivity; hypersensitivity; penicillin