cephalosporin allergy

Cephalosporin Allergy: Symptoms, Causes, and Treatment

Cephalosporin allergy refers to an adverse reaction to cephalosporins, a type of antibiotic commonly used to treat various bacterial infections. The symptoms of cephalosporin allergy can range from mild to severe and include:

• Rash: A rash is the most common symptom of cephalosporin allergy, occurring in up to 27% of patients [3].
• Itching: Itching or pruritus is another common symptom, often accompanied by a rash [8].
• Anaphylaxis: In severe cases, cephalosporin allergy can cause anaphylaxis, a life-threatening allergic reaction that requires immediate medical attention [5-11].

According to the literature, hypersensitivity reactions to cephalosporins are becoming increasingly common, with a wide range of immunopathologic mechanisms involved [6]. Cephalosporins are one of the leading causes for perioperative anaphylaxis and severe cutaneous adverse reactions [9].

Causes and Risk Factors

The exact cause of cephalosporin allergy is not fully understood. However, it is believed to be related to the immune system

Common Signs and Symptoms of Cephalosporin Allergy

Cephalosporin allergy can manifest in various ways, ranging from mild to severe reactions. Here are some common signs and symptoms:

• Rash: A maculopapular or morbilliform rash is the most commonly reported reaction to cephalosporins [1][3][5].
• Urticaria: Hives can appear on the skin, often accompanied by itching [2][6].
• Anaphylaxis: In severe cases, anaphylaxis can occur, which is a life-threatening condition that affects multiple body systems [4][7].
• Drug fever: A positive Coombs' test and drug fever are also common reactions to cephalosporins [3][5].

Other Possible Symptoms

In addition to the above symptoms, other possible signs of a cephalosporin allergy include:

• Flushing
• Angioedema (swelling of the face, lips, tongue, or throat)
• Rhinitis (stuffy nose)
• Bronchospasm (wheezing or difficulty breathing)
• Hypotension (low blood pressure)

References

[1] DA Khan · 2019 · Cited by 129 [2] A Romano · Cited by 2 [3] B ZEPF · 2002 · Cited by 3 [4] Common signs and symptoms of penicillin allergy include hives, rash and itching. [5] PS Kelkar · 2001 · Cited by 516 [6] A Romano — Signs and symptoms include various combinations of flushing, urticaria, angioedema, rhinitis, bronchospasm, hypotension, and anaphylactic shock ... [7] Oct 12, 2023 — Signs of a Severe Allergic Reaction

Diagnostic Tests for Cephalosporin Allergy

Cephalosporin allergy can be challenging to diagnose, but several diagnostic tests are available to help confirm the presence of an allergy. Here are some of the most common diagnostic tests used:

• Skin Testing: Skin testing with parent cephalosporins is a useful tool for evaluating reactions to cephalosporins [3]. The test involves injecting a small amount of the suspected allergen into the skin, and observing for any reaction.
• Basophil Activation Tests (BAT): BATs are in vitro tests that measure the activation of basophils, a type of white blood cell involved in allergic reactions. While BATs have lower sensitivity compared to skin testing, they can be useful in certain situations [5].
• Oral Challenges: Oral challenges involve administering small amounts of the suspected allergen orally and observing for any reaction. *

Treatment Options for Cephalosporin Allergy

Individuals allergic to cephalosporins may require alternative treatment options, especially if they have a history of severe reactions or allergies to other beta-lactam antibiotics. Here are some possible treatment approaches:

• Avoidance: The most common and recommended approach is to avoid using cephalosporins altogether, especially in patients with a history of severe penicillin hypersensitivity.
• Desensitization: In cases where cephalosporins are required, desensitization procedures can be performed under medical supervision. This involves gradually increasing the dose of the antibiotic to build tolerance.
• Alternative antibiotics: Other antibiotics like vancomycin or levofloxacin may be considered as alternatives in patients with cephalosporin allergy.

Important Considerations

When treating patients with cephalosporin allergy, it's essential to consider the following:

• Cross-reactivity: While some studies suggest cross-reactivity between penicillins and cephalosporins, others have found no significant correlation.
• Type I allergy: Patients with a history of Type I allergy (e.g., urticaria, laryngeal edema, bronchospasm) should not receive cephalosporins.
• Desensitization risks: Desensitization procedures carry some risks, including anaphylaxis and other severe reactions.

References

1. [12] The mechanism of penicillin allergy is thought to be the production of lymphocytotoxic metabolites.
2. [13] In vitro studies have shown a lack of cross-reactivity with similar molecules.
3. [14] Patients have been shown to tolerate other cephalosporins despite having a history of allergy to one specific type.

Consultation with an allergist or immunologist is recommended for personalized guidance on treating patients with cephalosporin allergy.

Understanding Cephalosporin Allergy Differential Diagnosis

Cephalosporin allergy differential diagnosis involves identifying the underlying cause of an allergic reaction to cephalosporins, a class of antibiotics. This is crucial for proper management and treatment.

• Cross-reactivity with penicillin: Patients reporting a penicillin allergy are at an increased risk for cross-sensitivity to cephalosporins [3]. This means that if a patient has had an allergic reaction to penicillin, they may also be allergic to cephalosporins.
• Unique cephalosporin haptens: Allergic reactions to cephalosporins