Cephalosporins can be given to penicillin-allergic patients who do not exhibit an anaphylactic response

• Published in: Journal of clinical anesthesia 2001-12, Vol.13 (8), p.561-564
• Main Authors: GOODMAN, Evan J, MORGAN, Michelle J, JOHNSON, Pat A, NICHOLS, Brenda A, DENK, Nevia, GOLD, Bianca B
• Format: Article
• Language: English
• Subjects: Anaphylaxis - chemically induced; Antibiotic Prophylaxis - adverse effects; Biological and medical sciences; Cephalosporins - administration & dosage; Cephalosporins - adverse effects; Cross Reactions; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - etiology; Drug toxicity and drugs side effects treatment; Female; Humans; Intraoperative Complications - etiology; Male; Medical sciences; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Orthopedic Procedures; Penicillins - adverse effects; Penicillins - immunology; Pharmacology. Drug treatments; Retrospective Studies
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/S0952-8180(01)00329-4

To assess the risk of intraoperative allergic reactions to cephalosporins in patients who claim to be allergic to penicillin. Retrospective chart review. University-affiliated hospital. 2,933 intraoperative anesthesia records of all adult orthopedic patients treated at our institution during a 14-month period (7/96-8/97) were reviewed for antibiotic use and allergic reactions. Most of the 2,933 orthopedic patients, including 413 patients who were allergic to penicillin, received a cephalosporin (usually cefazolin) during their procedure. Only one of the penicillin-allergic patients may have had an allergic reaction to the cephalosporin, because diphenhydramine and hydrocortisone were given at the beginning of the case. However, no mention was made on the chart about itching or a rash or hives. One of the non-penicillin-allergic patients did develop a rash while the cephalosporin was infusing, requiring discontinuation of the antibiotic. Given the low incidence of allergic reactions, it appears to be safe to administer cephalosporins to patients who claim to be allergic to penicillin. However, no conclusion can be made concerning patients who report severe or anaphylactic reactions to penicillin, because these patients probably were excluded from the study.