Cross-reactivity between a penicillin and a cephalosporin with the same side chain

BACKGROUND: The cross-reactivity between penicillins and cephalosporins can be influenced by different factors, which are not all well known. The chemical structure of the side chain may contribute to the cross-reactivity. OBJECTIVE: The study was carried out in allergic subjects who are selectively...

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Bibliographic Details
Published in:	Journal of allergy and clinical immunology Vol. 98; no. 3; pp. 671 - 677
Main Authors:	Miranda, Alfonso, Blanca, Miguel, Vega, Jose M., Moreno, Felisa, Carmona, Maria J., García, Juan J., Segurado, Elisardo, Justicia, Jose L., Juarez, Carlos
Format:	Journal Article
Language:	English
Published:	New York, NY Mosby, Inc 01-09-1996 Elsevier
Subjects:	Adolescent Adult Amoxicillin - chemistry Amoxicillin - immunology Ampicillin - chemistry Ampicillin - immunology Biological and medical sciences cephalosporins Cephalosporins - chemistry Cephalosporins - immunology Cross Reactions cross-reactivity Drug toxicity and drugs side effects treatment Female Humans Male Medical sciences Middle Aged Miscellaneous (drug allergy, mutagens, teratogens...) Penicillins Penicillins - chemistry Penicillins - immunology Pharmacology. Drug treatments side chain identity Skin Tests Structure-Activity Relationship BPO CFX-BA PV BPO-PLL cross-reactivity PHPG cephalosporins side chain identity AXO-BA AXO-PLL Penicillins MDM AXO Penicillin derivatives Human Drug Immunopathology Allergy Antibiotic Cephalosporin derivatives Side chain Toxicity Penicillin Cross reaction Antibacterial agent
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Summary:	BACKGROUND: The cross-reactivity between penicillins and cephalosporins can be influenced by different factors, which are not all well known. The chemical structure of the side chain may contribute to the cross-reactivity. OBJECTIVE: The study was carried out in allergic subjects who are selectively responsive to amoxicillin to determine allergenic cross-reactivity with a cephalosporin containing a side chain identical to that of amoxicillin, cefadroxil, and one containing a different side chain, cefamandole. METHODS: Allergic subjects with a selective response to amoxicillin were chosen according to the following criteria: history of an immediate allergic reaction to amoxicillin, negative skin test responses to benzylpenicilloyl and minor determinant mixture of benzylpenicillin, negative RAST response to benzylpenicilloyl, and good tolerance to benzylpenicillin and phenoxymethyl penicillin challenges. In addition, subjects had to have a positive skin test response to amoxicillin and/or positive RAST response to amoxicilloyl or, if these test results were negative, a positive challenge test response to amoxicillin. In vivo cross-reactivity to cefadroxil was assessed by giving oral cefadroxil at increasing doses from 5 to 500 mg. In vitro cross-reactivity was determined by RAST inhibition studies with amoxicilloyl RAST disks and the following monomeric conjugates in the fluid phase: amoxicillin-butylamine, cefadroxil-butylamine, and the side chain para-hydroxy-phenylglycine. Tolerance to cefamandole was determined by giving 100 mg and then 500 mg parenterally. RESULTS: Twenty-one patients with a selective response to amoxicillin were included in the study. Eight subjects (38%) had a positive response to cefadroxil, and none reacted to cefamandole. In vitro RAST inhibition studies indicated that cefadroxil-butylamine monomers cross-reacted with amoxicillin butylamine and the side chain contributed relevantly to the inhibition. CONCLUSIONS: These results indicate that the percentage of cross-reactivity between penicillins and cephalosporins with an identical side chain is high and that this critical part of the molecule seems to be an important contributor to these results. The value is higher than previously reported data from similar studies of non-side-chain–related cephalosporins. (J A LLERGY C LIN I MMUNOL 1996;98:671-7.)
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0091-6749 1097-6825
DOI:	10.1016/S0091-6749(96)70101-X