Allergy Asthma Immunol Res.  2014 Nov;6(6):485-495. 10.4168/aair.2014.6.6.485.

Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins

• Kim MH
• Lee JM

• KMID: 2260170
• DOI: http://doi.org/10.4168/aair.2014.6.6.485

Abstract

Cephalosporins can cause a range of hypersensitivity reactions, including IgE-mediated, immediate reactions. Cephalosporin allergy has been reported with use of a specific cephalosporin, as a cross-reaction between different cephalosporins or as a cross-reaction to other beta-lactam antibiotics. Unlike penicillins, the exact allergenic determinants of cephalosporins are less well understood and thus, standardized diagnostic skin testing is not available. Nevertheless, skin testing with diluted solutions of cephalosporins can be valuable in confirming IgE-mediated hypersensitivity reactions. In vitro tests are in development using recent technological advances and can be used as complementary tests. However, they are not commonly used because of their reduced sensitivity and limited availability. In selected cases of inconclusive results in both skin tests and IgE assays, a graded challenge or induction of drug tolerance with the implicated cephalosporin should be performed.

Keyword

Cephalosporins; immediate hypersensitivity; cross-reactions; diagnosis; management

MeSH Terms

Anti-Bacterial Agents
Cephalosporins*
Diagnosis*
Drug Tolerance
Hypersensitivity
Hypersensitivity, Immediate*
Immunoglobulin E
Penicillins
Skin Tests
Anti-Bacterial Agents
Cephalosporins
Immunoglobulin E
Penicillins

Figure

• 

  Fig. 1 Basic structure of β-lactam antibiotics.

• 

  Fig. 2 Use of a cephalosporin in patients with penicillin allergy.

• 

  Fig. 3 Use of penicillin in patients with cephalosporin allergy. Penicillin skin testing should include both major (Pre-Pen) and minor determinant reagents (MDM). When these reagents are not available, it is advisable to select a penicillin that have a dissimilar side chain to the culprit cephalosporin, and skin testing with that penicillin in its native form. If the results are negative, the patient may be treated with a graded challenge to the penicillin.

• 

  Fig. 4 Use of a cephalosporin in patients with cephalosporin allergy. A desensitization protocol should be performed in patients who require the culprit cephalosporin to which there is evidence of IgE-mediated allergy.

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