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

• Published in: Journal of allergy and clinical immunology 2016-07, Vol.138 (1), p.179-186
• Main Authors: Romano, Antonino, MD, Gaeta, Francesco, MD, Valluzzi, Rocco Luigi, MD, Maggioletti, Michela, MD, Caruso, Cristiano, MD, Quaratino, Donato, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Allergies; Allergy and Immunology; Aztreonam; Aztreonam - adverse effects; cephalosporins; Cephalosporins - adverse effects; challenges; Cross Reactions - immunology; cross-reactivity; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - immunology; Edema; Female; Humans; Hypersensitivity, Delayed - diagnosis; Hypersensitivity, Delayed - immunology; Immune Tolerance; Immunoglobulin E - immunology; Lymphocytes; Male; Middle Aged; nonimmediate reactions; Patch Tests; Penicillin; penicillins; Penicillins - adverse effects; Phenotype; Reading; Skin Tests; Studies; T-Lymphocytes - immunology; T-Lymphocytes - metabolism; tolerability; Young Adult
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2016.01.025

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 require 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 β-lactams, all subjects underwent skin tests with cephalexin, cefaclor, cefadroxil, cefuroxime, ceftriaxone, and aztreonam. Subjects with negative responses were challenged with the alternative β-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.