A moderate-risk history includes urticaria or other pruritic rashes and reactions with features of IgE-mediated reactions. Although many patients report that they are allergic to penicillin, clinically significant IgE-mediated or T lymphocyte-mediated penicillin hypersensitivity is uncommon (10 years) unknown reactions without features suggestive of an IgE-mediated reaction. Many patients report allergies to these drugs that limit their use, resulting in the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance and adverse events.Īpproximately 10% of the US population has reported allergies to the β-lactam agent penicillin, with higher rates reported by older and hospitalized patients. All rights reserved.Β-Lactam antibiotics are among the safest and most effective antibiotics. Eleven observational studies on carbapenem cross-reactivity involving 1127 penicillin-allergic patients showed that the risk of cross-reactivity to any carbapenem was 0.87% (95% CI, 0.32-2.32).Īlthough it remains possible that these meta-analyses overestimated the risk of cross-reactivity, clinicians should consider the increased risk of cross-reactivity associated with aminocephalosporins, and to a lesser extent with intermediate-similarity-score cephalosporins, compared with the very low risk associated with low-similarity-score cephalosporins and all carbapenems when using beta-lactams in patients with a suspected or proven penicillin allergy.īeta-lactam Carbapenem Cephalosporin Cross-reactivity IgE-mediated Meta-analysis Penicillin Systematic review T-cell–mediated.Ĭopyright © 2019 American Academy of Allergy, Asthma & Immunology. The higher risk associated with aminocephalosporins was observed whether penicillin allergy was IgE- or T-cell-mediated. Twenty-one observational studies on cephalosporin cross-reactivity involving 1269 penicillin-allergic patients showed that the risk of cross-reactivity varied with the degree of similarity between R1 side chains: 16.45% (95% CI, 11.07-23.75) for aminocephalosporins, which share an identical side chain with a penicillin (similarity score = 1), 5.60% (95% CI, 3.46-8.95) for a few cephalosporins with an intermediate similarity score (range, 0.563-0.714), and 2.11% (95% CI, 0.98-4.46) for all those with low similarity scores (below 0.4), irrespective of cephalosporin generation. A bioinformatic model was used to quantify the similarity between R1 side chains. Both random-effects and fixed-effect models were used to combine data. Cross-reactivity had to be assessed to at least 1 cephalosporin or carbapenem through ST or DPT. ![]() Studies had to include at least 10 penicillin-allergic subjects whose allergy had been confirmed by a positive skin test (ST) or drug provocation test (DPT) result. MEDLINE and EMBASE were searched from January 1980 to March 2019. To measure the association between R1 side chain similarity on cephalosporins and penicillins and the risk of cross-reactivity. ![]() To determine the risk of cross-reactivity to cephalosporins and carbapenems in patients with a proven IgE- or T-cell-mediated penicillin allergy. All past reviews have several limitations such as not including any patient with a T-cell-mediated penicillin allergy. There is no recent systematic review on the risk of cross-reactivity to cephalosporins and carbapenems in penicillin-allergic patients despite many new studies on the subject. 5 Centre Hospitalier Universitaire Sainte-Justine (CHU Sainte-Justine), Department of Pediatrics, Division of Clinical Immunology and Allergy, Université de Montréal, Montréal, QC, Canada Centre Hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Division of Clinical Immunology and Allergy, Montréal, QC, Canada.4 Centre Hospitalier Universitaire Sainte-Justine (CHU Sainte-Justine), Department of Pediatrics, Division of Clinical Immunology and Allergy, Université de Montréal, Montréal, QC, Canada.3 Faculty of Pharmacy, Université Laval and Medicinal Chemistry Laboratory, Centre Hospitalier Universitaire (CHU) de Québec Research Center, Québec, QC, Canada. ![]() Electronic address: 2 Institut National d'Excellence en Santé et Services Sociaux (INESSS), Montréal, QC, Canada. 1 Hôpital Maisonneuve-Rosemont (HMR), Department of Medicine, Division of Clinical Immunology and Allergy, Université de Montréal, Montréal, QC, Canada.
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