This potential cross-reactivity has extremely important therapeutic implications because many serious infections are best treated with cephalosporins as first-line therapy. Refer for penicillin challenge to local specialist or infectious diseases. It is commonly taught that at least 10 of patients who are allergic to penicillin will have an adverse reaction to cephalosporins. Patients tend to fall into 3 broad categories:Īlready given penicillin since the ‘allergy’ was documented OR ‘Allergy’ is really a side effect (e.g. Risk of true hypersensitivity reaction/allergyĭo not use penicillins continue label as ‘penicillin-allergic’Ĭontinue to label as ‘penicillin-allergic’ Use PENFAST a validated scoring system for assessing reported penicillin allergy. Take a detailed history of the allergy (see below): Sources of information include the patient, relatives, TRAK notes, ECS and general practice. Acute Generalised Exanthematous Pustulosis (AGEP).Drug Reaction with Eosinophilia & Systemic Symptoms (DRESS).Steven-Johnson Syndrome/Toxic Epidermal Necrolysis.People with a history of a Severe Cutaneous Adverse Reaction (SCAR) these are type 4 hypersensitivity reactions,.Anaphylaxis/Angioedema: Delabelling these patients is high-risk, and not done as an inpatient.Patients with a penicillin allergy label are more likely to come to harm through drug toxicity and poor outcomes from using non-beta lactam antibiotics. Background: Analysis of cross-reactivity is necessary for prescribing safe cephalosporins for penicillin allergic patients.Avoiding use of beta-lactams is associated with worse outcomes and more side effects.Allows you to use penicillin antibiotics for current infection (and all future infections).Cross-reactivity between penicillins and cephalosporins is ~2%, and mostly with 1st-generation cephalosporins cross-reactivity with aztreonam/carbapenems is rare (Amoxicillin & 1st-generation cephalosporins (cefalexin/cefazolin) Cross-reactivity between penicillins and cephalosporins or carbapenems is not a class effect but an allergic reaction to antibiotics with similar side.Most patients are allergic to the side-chain of the drug rather than the beta-lactam ring therefore, side chain homology determines cross-reactivity.Allergy to all beta-lactams is unlikely to exist.
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