Volume 136, Issue 3 p. 340-347
Review

Safe use of selected cephalosporins in penicillin-allergic patients: A meta-analysis

Michael E. Pichichero MD

Corresponding Author

Michael E. Pichichero MD

Department of Microbiology and Immunology, University of Rochester, Elmwood Pediatric Group, Otolaryngology, Head and Neck Surgery, University of Rochester Medical Center, Rochester, NY

Dr Pichichero has received research grants and/or honorariums, for CME speaking, or Ad hoc consulting, from the following companies: Abbott, Bristol-Myers/Squib, Glaxo SmithKline, Johnson & Johnson, Medimmune, Sanofi Aventis, and Sanofi Pasteur.Reprint requests: Michael E. Pichichero, MD, 601 Elmwood Avenue, Box 672, Rochester, NY 14642. E-mail: [email protected].Search for more papers by this author
Janet R. Casey MD

Janet R. Casey MD

Department of Microbiology and Immunology, University of Rochester, Elmwood Pediatric Group, Otolaryngology, Head and Neck Surgery, University of Rochester Medical Center, Rochester, NY

Search for more papers by this author
First published: 17 May 2016
Citations: 2

Abstract

Background

Recent analysis of clinical data and a clearer understanding of the role of chemical structure in the development of cross-reactivity indicate that the increased risk of an allergic reaction to a cephalosporin in penicillin-allergic patients is smaller than previously postulated.

Method

Medline and EMBASE databases were searched with the keywords: cephalosporin, penicillin, allergy, and crosssensitivity for the years 1960 through 2005. Among 219 articles retrieved, 9 served as source material for this evidence-based meta-analysis.

Results

A significant increase in allergic reactions to cephalothin (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.1 to 5.5), cephaloridine (OR = 8.7; CI = 5.9 to 12.8), and cephalexin (OR = 5.8; CI = 3.6 to 9.2), and all first generation cephalosporins plus cefamandole (OR = 4.8; CI = 3.7 to 6.2) were observed in penicillin allergic patients; no increase was observed with second generation cephalosporins (OR = 1.1; CI, 0.6 to 2.1) or third generation cephalosporins (OR = 0.5; CI = 0.2 to 1.1). Clinical challenges, skin testing, and monoclonal antibody studies point to the paramount importance of similarities in side chain structure to predict cross-allergy between cephalosporins and penicillins.

Conclusion

First-generation cephalosporins have cross-allergy with penicillins, but cross-allergy is negligible with second-and third-generation cephalosporins. Particular emphasis should be placed on the role of chemical structure in determining the risk of cross-reactivity between specific agents.

2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.