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Is there a 10% cross-sensitivity between penicillins and cephalosporins?

Publisher: East Anglia Medicines Information Service

Date published: 25/01/2012 16:01

Review date: 31/12/2013 19:00

Summary
by: Mark Cheeseman
  • It is commonly taught that approximately 10% of patients who are allergic to penicillin will have an adverse reaction to cephalosporins. However, within the medical literature this quoted cross-allergy risk of 10% has been questioned.
  • The widely cited rate of 10% cross-sensitivity to cephalosporins among penicillin allergic patients appears to be based on data collected and reviewed in the 1960s and 1970s and results of in vitro (immunological) tests that were not supported by clinical skin tests in penicillin-sensitive patients.
  • A meta-analysis published in 2007 identified the reasons why a 10% cross-sensitivity between penicillins and cephalosporins may be an overestimate.
  • The American Academy of Paediatrics (AAP) recommends prescribing cephalosporins in patients allergic to penicillin for sinusitis or otitis media. A review of the evidence to support the recommendation concluded coincidental allergic reactions to cephalosporins occur among penicillin/amoxicillin allergic patients. The authors suggest that a predictable, immunologically causal link for allergic reactions may occur with first generation cephalosporins (0.5% increased attributable risk) but most second- and third-generation agents are unlikely to be associated with cross-reactivity based on differences in their chemical structures compared to penicillins and early cephalosporins.
  • The information contained in the 56th and subsequent editions of the BNF now states that the hypersensitivity rate between penicillins and cephalosporins is 0.5% - 6.5%. In the UK, there is not a document similar to the AAP review recommending specific cephalosporin antibiotics for penicillin allergic patients with sinusitis or otitis media. Therefore, the latest prescribing information or specialist advice should always be consulted when considering the potential use of cephalosporin antibiotics in patients allergic to penicillin antibiotics.




 

 

Cross_sensitivitybetweenpensandcephs181_3.3.doc

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