CEPHALOSPORINS CAN BE GIVEN TO PENICILLIN-ALLERGIC PATIENTS WHO DO NOT EXHIBIT AN ANAPHYLACTIC RESPONSE.

Goodman EJ, et al. J Clin Anesth 2001 Dec;13(8):561-4.

STUDY OBJECTIVES: To assess the risk of intraoperative allergic reactions to cephalosporins in patients who claim to be allergic to penicillin.Design: Retrospective chart review.

SETTING: University-affiliated hospital.

MEASUREMENTS: 2,933 intraoperative anesthesia records of all adult orthopedic patients treated at our institution during a 14-month period (7/96-8/97) were reviewed for antibiotic use and allergic reactions.

MAIN RESULTS: Most of the 2,933 orthopedic patients, including 413 patients who were allergic to penicillin, received a cephalosporin (usually cefazolin) during their procedure. Only one of the penicillin-allergic patients may have had an allergic reaction to the cephalosporin, because diphenhydramine and hydrocortisone were given at the beginning of the case. However, no mention was made on the chart about itching or a rash or hives. One of the non-penicillin-allergic patients did develop a rash while the cephalosporin was infusing, requiring discontinuation of the antibiotic.

CONCLUSIONS: Given the low incidence of allergic reactions, it appears to be safe to administer cephalosporins to patients who claim to be allergic to penicillin. However, no conclusion can be made concerning patients who report severe or anaphylactic reactions to penicillin, because these patients probably were excluded from the study.

LACK OF ALLERGIC CROSS-REACTIVITY TO CEPHALOSPORINS AMONG PATIENTS ALLERGIC TO PENICILLINS.

Novalbos A, et al. Clin Exp Allergy 2001 Mar;31(3):438-43.

BACKGROUND: There are some contradicting data about clinical allergic cross-reactivity to cephalosporins among patients who have had a previous allergic reaction to penicillins. The purpose of this study was to assess the safety of administering cephalosporins to penicillin-allergic patients.

DESIGN: The diagnosis of penicillin allergy was made by positive skin tests to penicillin reagents and/or provocation tests with the penicillin suspected of causing the allergic reaction. To assess the clinical tolerance to cephalosporins, 41 well-characterized penicillin allergic patients diagnosed by positive skin tests and/or provocation tests were challenged with three cephalosporins that do not share the same side chain to the penicillin that induced the reactions: cephazoline, cefuroxime and ceftriaxone.

RESULTS: Skin prick and intradermal tests with all cephalosporins tested were negative. All penicillin-allergic patients tolerated therapeutic doses of the three cephalosporins tested (cephazoline, cefuroxime and ceftriaxone) without any ill effect.

CONCLUSION: These results indicate that the risk of suffering from an allergic reaction on administering cephalosporins to penicillin-allergic patients seems to be very low, provided that cephalosporins with a different side chain to the penicillin responsible for the allergic reaction are used.

COMMENTS: For a nice review article, follow this link.