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Rhyou HI, Nam YH, Kim SC, Doo GE, Ha CY, Nam HJ, Woo SD, Lee Y, Jang JH, Lee HY, Ye YM. Cefaclor-induced hypersensitivity: Differences in the incidence of anaphylaxis relative to other 2nd and 3rd generation cephalosporins. PLoS One 2021; 16:e0254898. [PMID: 34293048 PMCID: PMC8297852 DOI: 10.1371/journal.pone.0254898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/06/2021] [Indexed: 12/05/2022] Open
Abstract
Cefaclor, a second-generation oral cephalosporin, is the most frequently prescribed cephalosporin in Korea. Studies, however, have yet to analyze the incidence of cefaclor-associated adverse drug reactions (ADRs), including hypersensitivity (HS), according to total national usage rates. This study aimed to investigate the incidence rates and clinical features of cefaclor ADRs reported to the Korean Adverse Event Reporting System (KAERS) and Health Insurance Review and Assessment Service (HIRA) database for the most recent 5 years. Reviewing the HIRA database, which contains information on all insurance claims, including prescribed medications and patient demographics, we identified the total number of individuals who had been prescribed cefaclor and other cephalosporins including 2nd generation without cefaclor and 3rd generation antibiotics from January 2014 to December 2018. Additionally, we retrospectively analyzed all ADRs reported to the KAERS for these drugs over the same study period. Incidence rates for ADRs, HS, and anaphylaxis to cefaclor were 1.92/10,000 persons, 1.17/10,000 persons, and 0.38/10,000 persons, respectively, lower than those to other 2nd and 3rd cephalosporins. Among all ADRs, HS (60.9% vs. 43.6% vs. 44.8%, P <0.001) and anaphylaxis (19.8% vs. 4.6% vs. 4.7%, P <0.001) were more common for cefaclor than for other 2nd and 3rd cephalosporins. Females, individuals under 65 years of age, concomitant use of drugs, and serious ADRs were more strongly associated with HS to cefaclor than with HS to other 2nd and 3rd cephalosporins. In a nationwide database for the Korean population, the incidence of cefaclor-induced ADRs, particularly HS and anaphylaxis, was high. Female sex, age younger than 65 years, and concomitant use of drugs may be associated with HS to cefaclor.
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Affiliation(s)
- Hyo-In Rhyou
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, Busan, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, Busan, Korea
| | - Su-Chin Kim
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Go-Eun Doo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| | - Chae-Yeon Ha
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| | - Hee-Joo Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, Busan, Korea
| | - Sung-Dae Woo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Youngsoo Lee
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun-Young Lee
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Young-Min Ye
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
- * E-mail:
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Rhyou HI, Doo GE, Yoon J, Ha CY, Nam HJ, Woo SD, Lee Y, Nam YH, Ye YM. Clinical characteristics and risk factors for cefaclor-induced immediate hypersensitivity: a retrospective observation at two university hospitals in Korea. Allergy Asthma Clin Immunol 2021; 17:20. [PMID: 33588929 PMCID: PMC7885353 DOI: 10.1186/s13223-021-00523-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background Cefaclor, a second-generation oral cephalosporin, is widely prescribed to treat infectious diseases. Immediate hypersensitivity (HS) reactions to cefaclor have continuously been reported and are expected to increase with its greater use. This study aimed to investigate the clinical characteristics and risk factors of immediate HS to cefaclor over the most recent 5 years. Methods This retrospective study investigated 521 adverse drug reactions (ADRs) to cefaclor at pharmacovigilance centers at two tertiary hospitals from January 2014 to December 2018. In total, 459 patients with immediate HS to cefaclor were reviewed. Results A total of 459 cases of cefaclor immediate HS were included among 521 cefaclor ADRs, and anaphylaxis was recorded in 61.2%. Female sex (odds ratio 2.917, 95% confidence interval 2.397–3.550, P < 0.001), age under 65 years (4.225, 3.017–5.916, P < 0.001), hypertension (2.520, 1.875–3.388, P < 0.001), liver diseases (2.189, 1.208–3.967, P = 0.010), asthma (8.075, 5.301–12.302, P < 0.001), and concomitant use of nonsteroidal anti-inflammatory drugs (1.888, 1.554–2.294, P < 0.001) were significantly associated with cefaclor immediate HS. Conclusions Cefaclor was found to elicit high proportions of immediate HS and anaphylaxis. Physicians ought to be cautious with prescribing cefaclor to females, individuals with hypertension, liver diseases, or asthma, and patients taking nonsteroidal anti-inflammatory drugs. Trial registration This study was retrospectively registered.
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Affiliation(s)
- Hyo-In Rhyou
- Department of Internal Medicine, College of Medicine, Dong-A University, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea.,Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea
| | - Go-Eun Doo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Jiwon Yoon
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Chae-Yeon Ha
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Hee-Joo Nam
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea.,Department of Pharmacy, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea
| | - Sung-Dae Woo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea.,Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Youngsoo Lee
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea.,Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea. .,Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea.
| | - Young-Min Ye
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea. .,Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea.
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Abstract
PURPOSE Cefaclor is widely prescribed for various infectious diseases. As its consumption increases, the number of hypersensitivity reactions to cefaclor has increased. This study aimed to evaluate the immunologic findings of immediate hypersensitivity to cefaclor. MATERIALS AND METHODS We enrolled 47 patients with immediate hypersensitivity to cefaclor from Ajou University Hospital and Asan Medical Center. Serum specific IgE, IgG1, and IgG4 antibodies to cefaclor-human serum albumin (HSA) conjugate were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS The most common phenotype was anaphylaxis (Group I, 78.7%), followed by urticaria (Group II, 21.3%). The detection of specific IgE, IgG1, and IgG4 to cefaclor-HSA conjugate by ELISA tended to be higher in Group I (40.5%, 41.7%, 21.6%) than in Group II (20.0%, 20.0%, 0%) with no statistical significance. Significant associations were found between specific IgE and IgG1 or IgG4 (p<0.001, p=0.019). ELISA inhibition tests showed significant inhibitions by both free cefaclor and cefaclor-HSA conjugate. For basophil activation tests in patients having no specific IgE antibody, the CD63 expression level on basophils increased with incubations of free cefaclor. CONCLUSION The most common manifestation of immediate hypersensitivity to cefaclor was anaphylaxis, most of which was mediated by IgE; however, a non-IgE mediated direct basophil activation mechanism was suggested in a subset of anaphylaxis patients.
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Affiliation(s)
- Hye-Soo Yoo
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Hyun Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyouk-Soo Kwon
- Division of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Division of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Abstract
Adverse drug reactions are a common clinical problem. It has been estimated that 6% to 15% of hospitalized patients experience some sort of adverse drug reaction. Clinical manifestations of adverse drug reactions include skin rash; a serum sickness-like reaction; drug fever; pulmonary, hepatic, and renal involvement; and systemic anaphylaxis. Many of these adverse events are not immunologically mediated. Actual allergic or immunologic drug reactions probably account for <25% of adverse drug reactions overall. Antibiotics are one of the major contributors to drug hypersensitivity. Cefaclor, an oral second-generation cephalosporin with a beta-lactam ring, is used against various infectious diseases of the respiratory tract, especially in children. Several cases of cefaclor hypersensitivity have been reported. The most common presentations are either erythematous or papular eruptions, although serum sickness-like reactions have also been described. Anaphylactic reactions, although rare, have been observed in adults. Here we report a case of anaphylactic reaction to cefaclor in a 21/2-year-old patient.
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Affiliation(s)
- M Grouhi
- Toronto, Ontario, Canada M5G 1X8
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