IgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of alternative cephalosporins.
BACKGROUND
Studies regarding the cross-reactivity and tolerability of alternative cephalosporins in large samples of subjects with an IgE-mediated hypersensitivity to cephalosporins are lacking.


OBJECTIVE
We sought to evaluate the possibility of using alternative cephalosporins in subjects with cephalosporin allergy who especially require them.


METHODS
One hundred two subjects with immediate reactions to cephalosporins and positive skin test results to the responsible drugs underwent serum specific IgE assays with cefaclor and skin tests with different cephalosporins. Subjects were classified in 4 groups: group A, positive responses to 1 or more of ceftriaxone, cefuroxime, cefotaxime, cefepime, cefodizime, and ceftazidime; group B, positive responses to aminocephalosporins; group C, positive responses to cephalosporins other than those belonging to the aforementioned groups; and group D, positive responses to cephalosporins belonging to 2 different groups. Group A subjects underwent challenges with cefaclor, cefazolin, and ceftibuten; group B participants underwent challenges with cefuroxime axetil, ceftriaxone, cefazolin, and ceftibuten; and group C and D subjects underwent challenges with some of the aforementioned cephalosporins selected on the basis of their patterns of positivity.


RESULTS
There were 73 subjects in group A, 13 in group B, 7 in group C, and 9 in group D. Challenges with alternative cephalosporins (ceftibuten in 101, cefazolin in 96, cefaclor in 82, and cefuroxime axetil and ceftriaxone in 22 subjects) were well tolerated.


CONCLUSIONS
Cephalosporin hypersensitivity does not seem to be a class hypersensitivity. Subjects with cephalosporin allergy who especially require alternative cephalosporins might be treated with compounds that have side-chain determinants different from those of the responsible cephalosporins and have negative pretreatment skin test responses.
Allergy Unit, Complesso Integrato Columbus, Rome, Italy; IRCCS Oasi Maria S.S., Troina, Italy. Electronic address: antoninoromano@h-columbus.it.
Antonino
A
Romano
Allergy Unit, Complesso Integrato Columbus, Rome, Italy.
Francesco
F
Gaeta
Allergy Unit, Complesso Integrato Columbus, Rome, Italy.
Rocco Luigi
RL
Valluzzi
Allergy Unit, Complesso Integrato Columbus, Rome, Italy.
Michela
M
Maggioletti
Ambulatorio di Allergologia, IDI-IRCCS, Capranica, Italy.
Alessandra
A
Zaffiro
Allergy Unit, Complesso Integrato Columbus, Rome, Italy.
Cristiano
C
Caruso
Ambulatorio di Allergologia, IDI-IRCCS, Capranica, Italy.
Donato
D
Quaratino
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000737:chemistry / Q000145:classification / Q000276:immunology* / Q000627:therapeutic use; D002511:Cephalosporins / Q000737:chemistry / Q000145:classification / Q000276:immunology* / Q000627:therapeutic use; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000276:immunology / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced / Q000276:immunology / Q000473:pathology / Q000517:prevention & control*; D007108:Immune Tolerance; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012882:Skin Tests
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D007073:Immunoglobulin E
Cephalosporin allergy; cross-reactivity; skin tests; tolerability