Reactions 1288 - 13 Feb 2010

SCephalosporins

Drug hypersensitivity: 6 case reportsSix patients aged 12 to 56 years experienced IgE-

mediated drug hypersensitivity to cefaclor, cefalexin,cefuroxime or cefazolin [therapeutic indications anddosages not stated].

None of the patients had documented hypersensitivity topenicillin. They all experienced immediate reactions [seetable], within 1 hour of receiving their respective drug.Patients 1, 3 and 6 developed isolated urticaria, while inpatient 2, urticaria was accompanied by angioedema.Patients 4 and 5 experienced anaphylaxis (consisting ofcardiovascular symptoms plus systemic pruritus,generalised erythema, breathing difficulty or dysphonia)[treatments and outcomes not stated].

Patient, drugs and reactionsPatient/sex/age (y) Drug Clinical reaction

1/F/15 Cefaclor Urticaria2/M/53 Cefalexin Urticaria,

angioedema3/F/56 Cefuroxime Urticaria4/M/12 Cefazolin Anaphylaxis5/F/40 Cefuroxime Anaphylaxis6/F/43 Cefuroxime Urticaria

Patients 4 and 5 returned positive skin tests withcefazolin (wheal of 30mm) and cefuroxime (wheal of28mm), respectively. During oral challenge tests, fourpatients reacted to the drug which had affected themclinically: patients 1 and 2 experienced anaphylaxis,patients 3 and 6 developed urticaria, and patient 6 alsoexperienced angioedema. In addition, patient 2 had apositive oral challenge test to cefaclor (urticaria) as well asto cefalexin, and patient 3 tested positive to cefalexin(urticaria) as well as cefuroxime. Nine oral challenge testscarried out with different penicillins were all negative. Allpatients were considered to have IgE hypersensitivity totheir respective, clinically-administered drug, althoughpatients 2, 3, 4 and 6 were able to tolerate othercephalosporins.

Author comment: "[W]e have shown that in non-penicillin-allergic patients with a suspected IgE-mediatedreaction to a cephalosporin, a positive skin test to thatcephalosporin implies the presence of drug-specific IgEantibodies and the patient should receive an alternative drugor undergo desensitisation."Somech R, et al. Evaluation of immediate allergic reactions to cephalosporins innon-penicillin-allergic patients. [Review] [19 refs]. International Archives ofAllergy and Immunology 150: 205-9, No. 3, 2009 - Canada 803005814

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Reactions 13 Feb 2010 No. 12880114-9954/10/1288-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved