Β-lactam allergy: Difference between revisions
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Β-lactam allergy
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==Cross-reactivity== |
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! rowspan="2" |Antibiotic |
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! colspan="3" align="center" |C7 |
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! colspan="7" align="center" |C3 |
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!G1 |
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| [[Penicillin]] |
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|[[Penicillin]] |
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|[[Ampicillin]] |
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|[[Amoxicillin]] |
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|[[Cefazolin]] |
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|[[Cephalexin]] |
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|[[Cefadroxil]] |
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|[[Cephalothin]] |
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|[[Cefotetan]] |
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|[[Cefoxitin]] |
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|[[Cefuroxime]] |
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|[[Cefaclor]] |
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|[[Ceftriaxone]] |
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|[[Ceftazidime]] |
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|[[Ceftaroline]] |
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=== |
===C-7 Side Chains=== |
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* '''Group 2:''' [[amoxicillin]], [[ampicillin]], [[cefaclor]], [[cephalexin]], [[cefadroxil]] |
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* |
*'''Group 1:''' [[penicillin]], [[cephalothin]], [[cefoxitin]] |
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*'''Group 2:''' [[amoxicillin]], [[ampicillin]], [[cefaclor]], [[cephalexin]], [[cefadroxil]] |
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*'''Group 3:''' [[cefipime]], [[cefotaxime]], [[ceftriaxone]] |
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[[File:zagursky2017.jpg|Comparison of R1 and R2 structural similarities between b-lactam drugs]] |
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Drugs that have identical R1 or R2 structures are listed as R1 (red cell) or R2 (gold cell). If only the ring or branch chain moiety of the R1 structure is identical, it is listed as R10 or R100, respectively. Drugs that have similar R1 or R2 structures are listed as r1 or r2. If only the ring or branch chain moiety of the R1 structure is similar, it is listed as r10 or r100, respectively. Blank cells imply no R1 or R2 structural similarities. |
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*'''Group 2:''' [[cefotetan]] |
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== |
==Hypersensitivity Reactions== |
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* |
*'''Type I (IgE-mediated)''' |
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**Anaphylaxis |
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**Itchy rash |
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**Penicillins '''should be avoided''' |
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*'''Type II (IgG-mediated)''' |
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**Non-itchy rash |
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**Rash will improve if treatment continues, '''no need to avoid''' penicillins |
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*'''Type IV (cell-mediated)''' |
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**Toxic epidermal necrolysis |
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**Stevens-Johnson syndrome |
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**Penicillins '''should be avoided''' |
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== |
==Further Reading== |
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* |
*Zagursky RJ and Pichichero ME. Cross-reactivity in β-Lactam Allergy. ''J Allergy Clin Immunol Pract''. 2018;6(1):72-81.e1. doi: [https://doi.org/10.1016/j.jaip.2017.08.027 10.1016/j.jaip.2017.08.027] |
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[[Category:Antibiotics]] |
[[Category:Antibiotics]] |
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Revision as of 18:07, 16 August 2020
Cross-reactivity
| Antibiotic | C7 | C3 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| G1 | G2 | G3 | G1 | G2 | G3 | G4 | G5 | G6 | G7 | |
| Penicillin | X | |||||||||
| Ampicillin | X | |||||||||
| Amoxicillin | X | |||||||||
| Cefazolin | ||||||||||
| Cephalexin | X | X | ||||||||
| Cefadroxil | X | X | ||||||||
| Cephalothin | X | X | ||||||||
| Cefotetan | X | |||||||||
| Cefoxitin | X | X | ||||||||
| Cefuroxime | X | |||||||||
| Cefaclor | X | |||||||||
| Cefotaxime | X | X | ||||||||
| Ceftriaxone | X | |||||||||
| Ceftazidime | X | |||||||||
| Cefixime | X | |||||||||
| Cefdinir | ||||||||||
| Cefipime | X | |||||||||
| Ceftaroline | ||||||||||
C-7 Side Chains
- Group 1: penicillin, cephalothin, cefoxitin
- Group 2: amoxicillin, ampicillin, cefaclor, cephalexin, cefadroxil
- Group 3: cefipime, cefotaxime, ceftriaxone
C-3 Side Chains
- Group 1: cefadroxil, cephalexin
- Group 2: cefotetan
- Group 3: cefotaxime, cephalothin
- Group 4
- Group 5: cefuroxime, cefoxitin
- Group 6: cefixime
- Group 7: ceftazidime
Hypersensitivity Reactions
- Type I (IgE-mediated)
- Anaphylaxis
- Itchy rash
- Penicillins should be avoided
- Type II (IgG-mediated)
- Non-itchy rash
- Rash will improve if treatment continues, no need to avoid penicillins
- Type IV (cell-mediated)
- Toxic epidermal necrolysis
- Stevens-Johnson syndrome
- Penicillins should be avoided
Further Reading
- Zagursky RJ and Pichichero ME. Cross-reactivity in β-Lactam Allergy. J Allergy Clin Immunol Pract. 2018;6(1):72-81.e1. doi: 10.1016/j.jaip.2017.08.027
References
- ^ Brittany Kula, Gordana Djordjevic, Joan L. Robinson. A Systematic Review: Can One Prescribe Carbapenems to Patients With IgE-Mediated Allergy to Penicillins or Cephalosporins?. Clinical Infectious Diseases. 2014;59(8):1113-1122. doi:10.1093/cid/ciu587.
- ^ Anna R. Wolfson, Emily M. Huebner, Kimberly G. Blumenthal. Acute care beta-lactam allergy pathways: approaches and outcomes. Annals of Allergy, Asthma & Immunology. 2019;123(1):16-34. doi:10.1016/j.anai.2019.04.009.
- ^ Erica S. Shenoy, Eric Macy, Theresa Rowe, Kimberly G. Blumenthal. Evaluation and Management of Penicillin Allergy. JAMA. 2019;321(2):188. doi:10.1001/jama.2018.19283.
