Anaphylactic reaction to cephalothin during anesthesia

A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients

The American Academy of Pediatrics, evidence-based guidelines endorse the use of cephalosporin antibiotics for patients with reported allergies to penicillin, for the treatment of acute bacterial sinusitis and acute otitis media. Many physicians, however, remain reluctant to prescribe such agents. Although such concern is understandable, lack of consistent data regarding exactly what constitutes an initial penicillin-allergic reaction and subsequent cross-sensitivity to cephalosporins may be preventing many patients from receiving optimal antibiotic therapy. This article reviews evidence in support of the American Academy of Pediatrics recommendation. Included is an examination of the types and incidence of reactions to penicillins and cephalosporins; the frequency of cross-reactivity between these 2 groups of agents; experimental and clinical studies that suggest that side chain-specific antibodies predominate in the immune response to cephalosporins, thereby explaining the lack of cross-sensitivity between most cephalosporins and penicillins; the role of skin testing; and the risks of anaphylaxis. Specific recommendations for the treatment of patients on the basis of their responses to previously prescribed agents are summarized.

Penicillin-induced anaphylaxis in a patient under hypotensive anesthesia

Elective use of penicillin during hypotensive anesthesia for orthognathic surgery induced a nearly fatal anaphylactic reaction. The first symptom of anaphylaxis was increased inspiratory resistance to mechanical ventilation, followed by severe hypotension. The therapeutic management of anaphylaxis is discussed. Patients susceptible to reactions from the administration of B-lactam antibiotics can be identified through skin tests. Patients reactive to such antibiotics should be treated with alternate antibiotics or they should be desensitized prior to receiving penicillin.