Cross-reactivity and tolerability of aztreonam and cephalosporins in subjects with a T cell-mediated hypersensitivity to penicillins

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:138

Article

Romano, Antonino^1,2  Gaeta, Francesco¹  Valluzzi, Rocco Luigi¹  Maggioletti, Michela¹  Caruso, Cristiano¹  Quaratino, Donato³ 

[1] Complesso Integrato Columbus, Allergy Unit, Via G Moscati 31, I-00168 Rome, Italy

[2] IRCCS Oasi Maria SS, Troina, Italy

[3] IDI IRCCS, Ambulatorio Allergol, Capranica, Italy

关键词: Aztreonam;    cephalosporins;    challenges;    cross-reactivity;    nonimmediate reactions;    penicillins;    tolerability;    skin tests;   

DOI  :  10.1016/j.jaci.2016.01.025

来源: Elsevier

【 摘 要 】

Background: The few studies performed in adults with T cell-mediated hypersensitivity to penicillins have found a rate of cross-reactivity with cephalosporins ranging from 2.8% to 31.2% and an absence of cross-reactivity with aztreonam. Objective: We sought to evaluate the possibility of using cephalosporins and aztreonam in subjects with documented delayed hypersensitivity to penicillins who especially req(u)ire them. Methods: We conducted a prospective study of 214 consecutive subjects who had 307 nonimmediate reactions to penicillins (almost exclusively aminopenicillins) and had positive patch test and/or delayed-reading skin test responses to at least 1 penicillin reagent. To assess cross-reactivity with cephalosporins and aztreonam and the tolerability of such alternative beta-lactams, all subjects underwent skin tests with cephalexin, cefaclor, cefadroxil, cefuroxime, ceftriaxone, and aztreonam. Subjects with negative responses were challenged with the alternative beta-lactams concerned. Results: All subjects had negative skin test results to cefuroxime, ceftriaxone, and aztreonam and tolerated challenges. Forty (18.7%) of the 214 subjects had positive skin test responses to at least 1 aminocephalosporin. Of the 174 subjects with negative responses, 170 underwent challenges; 1 reacted to cefaclor. Conclusions: These data demonstrate a rate of cross-reactivity between aminopenicillins and aminocephalosporins (ie, cephalexin, cefaclor, and cefadroxil) of around 20%, as well as the absence of cross-reactivity between penicillins and cefuroxime, ceftriaxone, and aztreonam in all subjects with T cell-mediated hypersensitivity to penicillins, almost exclusively aminopenicillins. Therefore these subjects could be treated with cefuroxime, ceftriaxone, and aztreonam. In those who especially require cephalosporin or aztreonam treatment, however, we recommend pretreatment skin tests because negative responses indicate tolerability.

【 授权许可】

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