This series of 234 truly penicillin-allergic patients confirms published data on a very low risk of cross-reactivity, inferior to 1%, with different side chain-bearing cephalosporins like cefuroxime, ceftriaxone and cefpodoxime.
#Penicillin allergy cross reactivity skin
We evaluated 234 true penicillin-allergic subjects and found only 1/159 positive challenge to ceftriaxone and only 1/76 positive skin test to cefuroxime, in agreement with published data on IHS and DHS. Only 1/159 (0.6%) challenged with ceftriaxone had positive DPT (acute urticaria) and tolerated subsequent DPT with cefpodoxime. Four hundred forty-two challenges were performed in 234 patients, with no allergic reaction in 158/159 DPT with ceftriaxone, all 198 with cefpodoxime, all 6 with cefixime and all 79 with cefuroxime. In 54 DHS to penicillin patients, 117 negative skin tests with 2CG (n=23) and 3CG (n=94) were performed. Frequency of 4.4 (95 CrI, 0 to 23. Only 1/76 (1.3%) tested with 2CG (cefuroxime) had positive immediate skin test, being negative on skin tests and drug provocation test (DPT) with 3CG cefpodoxime and ceftriaxone. Penicillin allergy in surgical patients with a cefazolin allergy. Of 380 skin tests performed in 180 IHS to penicillin patients, all 304 tests with 3CG were negative (144 ceftriaxone, 156 cefpodoxime and 4 cefixime). All 234 patients had positive skin tests with amoxicillin and/or amoxicillin-clavulanic acid. Among 234 patients included, 180 (77%) and 54 (23%) patients had proven IHS and DHS to penicillin, for a total of 270 HS reactions (196 IHS and 74 DHS): anaphylaxis, acute urticaria and/or angioedema, cutaneous adverse drug reaction, rash, unknown DHS, delayed urticaria and/or angioedema and unknown IHS respectively in 118, 47, 39, 11, 10, 5 and 4 cases. We conducted a retrospective study including 234 adults with proven HS to penicillin based on history according to EAACI criteria (2) and positive skin tests (immediate or delayed readings) to at least one penicillin, explored in our unit for 3CG and 2CG HS cross-reactivity. Our objective was to assess cross-reactivity with 3CG and 2CG in penicillin-proven allergic patients. Historic risk of 10-30% was probably overestimated, actual risk of cross-reactivity with different side chain third generation cephalosporins (3CG) could be around 1% (1). In both immediate (IHS) and delayed hypersensitivity reactions (DHS) cross-reactivity between penicillins/cephalosporins is mainly related to side-chain similarities and concerns first and second-generation cephalosporins (2CG).
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