Cephalosporin use in treatment of patients with penicillin allergies

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Objective: To review the evidence that supports the use of certain cephalosporins in penicillin-allergic patients. Data sources: Published articles were identified through Medline and EMBASE (1960-2007) using the search terms penicillin and allergy and cephalosporin and cross-reactivity. Additional sources were identified from the authors' personal collection and the reference bibliographies. Study selection: The articles found in the search were limited to the English language and screened for relevance. Review articles and republication of results were excluded. A total of 44 articles reported evidence of cross-reactivity between cephalosporins and penicillins in human and animal studies. Additional references provided background and perspective. Data synthesis: Physicians may now prescribe certain cephalosporins in patients with a history of a nonserious, non-life-threatening penicillin reaction. Exclusions include type I anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, and other potentially life-threatening responses to medication. Recent reports demonstrate that a considerable body of literature describing the cross-reactivity between cephalosporins and penicillin was established based on nonallergic adverse reactions or in vitro studies rather than on clinically relevant immune-mediated reactions. Oral rechallenge and skin testing data support the relationship of the beta-lactam side-chain structures of these drugs as a predictor of cross-reactivity. Conclusion: Recent data suggest that the incidence of cross-reactivity among penicillins and cephalosporins is lower than historically reported. Pharmacists should be aware that cephalosporin cross-reactivity in a penicillin-allergic patient is not necessarily a class effect. Dispensing should be evaluated based on the type of allergic manifestations and the drug prescribed.

Publication Title, e.g., Journal

Journal of the American Pharmacists Association