A statement on cefazolin immediate hypersensitivity: data from a large database, and focus on the cross-reactivities

作者：Pipet A^*; Veyrac G; Wessel F; Jolliet P; Magnan A; Demoly P; Bousquet P J

来源：Clinical and Experimental Allergy, 2011, 41(11): 1602-1608.

DOI：10.1111/j.1365-2222.2011.03846.x

• beta-lactams
• cefazolin
• cephalosporin
• drug hypersensitivity
• penicillin

Background More perioperative cefazolin use has resulted in an increased risk of cefazolin-associated reactions.
Objective The aim of this article is to study immediate reactions to cefazolin and attempt to determine possible allergic cross-reactivity with other beta-lactams using data from the Drug Allergy and Hypersensitivity Database (DAHD).
Methods All 25 cefazolin-associated reactions in the DAHD were reviewed. The cases identified were then investigated according to the European Network for Drug Allergy (ENDA) recommendations by skin testing and challenges.
Results A total of 10 individuals with proven IgE-mediated cefazolin hypersensitivity were identified between January 1999 and July 2009. All the index reactions were compatible with an acute IgE-mediated process, six with anaphylaxis, two with systemic allergic reactions without hypotension, and two with urticaria/angioedema. Cefazolin skin tests were positive in seven individuals and cefazolin challenges were positive in three more individuals. In the eight cefazolin allergic patients who had challenges with other beta-lactams, there was no positive reaction noted.
Conclusion and Clinical Relevance In this cohort of patients with IgE-mediated reactions to cefazolin, a majority tolerated amoxicillin and several patients tolerated other cephalosporins. This implies that the R1 side-chain may play an essential role in IgE-mediated reactions to cefazolin. No clear rule to predict cross-reactivity with other beta-lactams could be determined. More research on IgE-mediated hypersensitivity to cefazolin and other cephalosporins is needed.

• 出版日期2011-11