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Results of cephalosporin challenges in patients with histories of penicillin allergy

Results of cephalosporin challenges in patients with histories of penicillin allergy
Study Cephalosporin reaction rate Cephalosporins administered Type of reaction
(causative drug)
History of penicillin allergy (%) No history of penicillin allergy (%)
Dash (1975)[1] 25 of 324 (7.7%) 140 of 17,216 (0.8%) Cephalexin and cephaloridine No details given
Petz (1978)[2] 57 of 701 (8.1%) 285 of 15,007 (1.9%) Cephalexin, cephaloridine, cephalothin, cefazolin, and cefamandole No details given
Goodman (2001)[3] 1 of 300 (0.3%) 1 of 2431 (0.04%) Cefazolin (in all but one patient) Reaction was questionable
Daulat (2004)[4] 1 of 606 (0.17%) 15 of 22,664 (0.07%) First generation (42%)

Reaction was eczema

(cefazolin)
Second generation (21%)  
Third/fourth generation (37%)  
Fonacier (2005)[5] 7 of 83 (8.4%) Not applicable First generation (59%)

Reactions were convincing:

(Cephalexin-1)
Second generation (8.4%) (Cefaclor-2, cefuroxime-2)
Third generation (25%) (Cefixime-1, ceftriaxone-1)
Fourth generation (7%)  
MacPherson (2006)[6] 0 of 84 (0) Not applicable Cefazolin, cefotetan, ceftriaxone  
Crotty (2015)[7] 7 of 186 (3.8%) Not applicable Cephalexin, cefoxitin, ceftriaxone, and cefepime Six of seven reactions were due to cefepime; three of seven reactions were immediate
Beltran (2015)[8] 1 of 153 (0.7%) Not applicable

Cefazolin (84%)

Cefoxitin (17%)

Reaction was urticarial

(cefazolin)
Summary of studies of cephalosporin challenges in patients with a history of penicillin allergy without preceding penicillin allergy testing.
References:
  1. Dash CH. Penicillin allergy and the cephalosporins. J Antimicrob Chemother 1975; 1:107.
  2. Petz LD. Immunologic cross-reactivity between penicillins and cephalosporins: a review. J Infect Dis 1978; 137 Suppl:S74.
  3. Goodman EJ, Morgan MJ, Johnson PA, et al. Cephalosporins can be given to penicillin-allergic patients who do not exhibit an anaphylactic response. J Clin Anesth 2001; 13:561.
  4. Daulat S, Solensky R, Earl HS, et al. Safety of cephalosporin administration to patients with histories of penicillin allergy. J Allergy Clin Immunol 2004; 113:1220.
  5. Fonacier L, Hirschberg R, Gerson S. Adverse drug reactions to a cephalosporins in hospitalized patients with a history of penicillin allergy. Allergy Asthma Proc 2005; 26:135.
  6. MacPherson RD, Willcox C, Chow C, Wang A. Anaesthetist's responses to patients' self-reported drug allergies. Br J Anaesth 2006; 97:634.
  7. Crotty DJ, Chen XJ, Scipione MR, et al. Allergic Reactions in Hospitalized Patients With a Self-Reported Penicillin Allergy Who Receive a Cephalosporin or Meropenem. J Pharm Pract 2015.
  8. Beltran RJ, Kako H, Chovanec T, et al. Penicillin allergy and surgical prophylaxis: Cephalosporin cross-reactivity risk in a pediatric tertiary care center. J Pediatr Surg 2015; 50:856.
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