Cephalosporins, which are the most frequently prescribed class of antibiotics, are related to penicillin in their structure, uses and effects.
“Almost all patients undergoing major surgery receive antibiotics to reduce the risk of infections. Many patients with a history of penicillin allergy don’t get the cephalosporin because of a concern of possible drug reaction. They might get a second-choice antibiotic that is not quite as effective,” said lead study author James T. Li, MD, PhD, FAAAAI.
Researchers at the Mayo Clinic sought to review the skin test results of patients with a history of anaphylaxis to penicillin and compare them to the risk of reactions to cephalosporins. Could the patients with negative skin tests safely take these medications?
For the study, a penicillin allergy database was searched for patient reported anaphylaxis. Out of 15,298 patients with a history of penicillin allergy who were evaluated by an allergist, 193 patients reported a history of an anaphylactic reaction to penicillin. These patients’ charts were then reviewed for penicillin skin test results, whether they had been given cephalosporins before an operation and for possible adverse drug events.
Of the 193 patients, 15 were not tested due to negative histamine controls. From the 178 patients who were skin tested for penicillin allergy, 10 patients had unclear results, 12 had positive skin tests and 156 had negative skin tests to penicillin.
Eighty of the 156 patients who had negative skin tests to penicillin later received a cephalosporin for surgery. Only one of these patients had a possible mild adverse drug reaction.
“Even patients with a history of a serious reaction to penicillin can receive cephalosporins safely if the allergy tests are negative. The main message here is that patients with a history of penicillin allergy who need surgery can benefit from consultation with an allergist. They can get the best antibiotic with the lowest risk of drug reaction,” added Li.
The AAAAI (www.aaaai.org) represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has nearly 6,500 members in the United States, Canada and 60 other countries. To find an allergist/immunologist in your area, visit www.aaaai.org/physref.
- This study was presented during the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) on February 26-March 2 in New Orleans. However, it does not necessarily reflect the policies or the opinions of the AAAAI.
- A link to all abstracts presented at the Annual Meeting is available at annualmeeting.aaaai.org
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