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Daniel D, Bacchi S, Casson R, Chan W. Sulfonamides in ophthalmology: adverse reactions : Evidence-based use of sulfa drugs in ophthalmology. Int Ophthalmol 2024; 44:214. [PMID: 38700759 PMCID: PMC11068664 DOI: 10.1007/s10792-024-03045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 05/06/2024]
Affiliation(s)
- David Daniel
- The University of Adelaide, Adelaide, Australia.
| | | | | | - Weng Chan
- The University of Adelaide, Adelaide, Australia
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Fernandez J, Jimenez-Rodriguez TW, Blanca-Lopez N. Classifying cephalosporins: from generation to cross-reactivity. Curr Opin Allergy Clin Immunol 2021; 21:346-354. [PMID: 34074874 DOI: 10.1097/aci.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To review the most recent literature studying the classifications, immunochemistry, and crossreactivity of allergy reactions to cephalosporins. RECENT FINDINGS Over the last five years, research interest has focused on three areas related to cephalosporin allergy: cross-reactivity among cephalosporins and with other beta-lactams; the incidence of adverse reactions in penicillin allergy patients or in reported penicillin allergy labels; and new cephalosporins structures involved in the immunological recognition. SUMMARY Meta-analysis of a substantial number of studies shows that cephalosporins are safer than previously thought. Evidence supports two main conclusions in that regard. First, there is a relatively low percentage of cross-reactivity between cephalosporins and other beta-lactams with penicillins in penicillin allergy patients. Second, there is a very low incidence of allergy reactions in nonselected as well as in selected penicillin allergy patients when cephalosporins are used prior to surgical intervention.On the other hand, few structures have been discovered related to the immune mechanism of cephalosporin allergy reactions, and these are far from being ready to use in clinical practice.
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Affiliation(s)
- Javier Fernandez
- Allergy Section, Alicante General University Hospital, ISABIAL-UMH, Alicante
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Signal Detection of Adverse Drug Reactions of Cephalosporins Using Data from a National Pharmacovigilance Database. Pharmaceuticals (Basel) 2021; 14:ph14050425. [PMID: 34063258 PMCID: PMC8147424 DOI: 10.3390/ph14050425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022] Open
Abstract
This case-non-case study aims to detect signals not currently listed on cephalosporin drug labels. From 2009 to 2018, adverse event (AE) reports concerning antibacterial drugs (anatomical therapeutic chemical (ATC) code J01) in the Korea Adverse Events Reporting System (KAERS) database were examined. For signal detection, three indices of disproportionality, proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC), were calculated. The list of signals was compared with ADRs on the drug labels from the United States, United Kingdom, Japan, and South Korea. A total of 163,800 cephalosporin-AE combinations and 72,265 all other J01-AE combinations were analyzed. This study detected 472 signals and 114 new signals that are not included on the drug labels. Cefatrizine-corneal edema (PRR, 440.64; ROR, 481.67; IC, 3.84) and cefatrizine-corneal ulceration (PRR, 346.22; ROR, 399.70; IC, 4.40) had the highest PRR, ROR, and IC among all signals. Additionally, six serious AEs that were not listed on drug labels such as cefaclor-induced stupor (ten cases) and cefaclor-induced respiratory depression (four cases) were found. Detecting signals using a national pharmacovigilance database is useful for identifying unknown ADRs. This study identified signals of cephalosporins that warrant further investigation.
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Yuson C, Kumar K, Le A, Ahmadie A, Banovic T, Heddle R, Kette F, Smith W, Hissaria P. Immediate cephalosporin allergy. Intern Med J 2020; 49:985-993. [PMID: 30667130 DOI: 10.1111/imj.14229] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/18/2018] [Accepted: 01/09/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients who suffer from acute IgE-mediated allergy to a cephalosporin antibiotic are frequently assumed to be at high risk of allergy to other cephalosporins and penicillins. AIM To define cross-reactivity patterns in patients with confirmed allergy to a cephalosporin. METHODS Subjects presenting with a history of immediate allergy to a cephalosporin-family antibiotic between March 2009 and July 2017 were investigated with specific IgE testing to penicillin, amoxycillin and cefaclor, followed by skin prick testing, intradermal testing and drug provocation testing with a panel of penicillins and cephalosporins. RESULTS Out of 564 subjects with a reported beta-lactam allergy, 90 identified a cephalosporin as their index drug. Fifty-five (61.1%) of the 90 subjects tested had a history consistent with an IgE-mediated reaction, of whom 24 (43.6%) were proven to be allergic to their index cephalosporin. Twenty (83.3%) of the 24 were allergic only to their index cephalosporin. Of the four remaining subjects, two were co-sensitised to another beta-lactam with a similar side chain, while the other two had no specific cross-reactivity pattern. Major and minor penicillin determinants were negative for all cephalosporin-allergic individuals. CONCLUSION In our cohort, cephalosporin allergy does not appear to be a class effect, with most cases found allergic only to their index cephalosporin. Co-sensitisation to other cephalosporins or penicillins was uncommon, and when it occurred, was usually consistent with side chain cross-reactivity.
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Affiliation(s)
- Carlo Yuson
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kimti Kumar
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Adriana Le
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aida Ahmadie
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tatjana Banovic
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert Heddle
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Frank Kette
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - William Smith
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Pravin Hissaria
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Foreman C, Le TTA, Inglis JM, Smith WB. Penicillin allergy labeling on medical alert jewelry. Ann Allergy Asthma Immunol 2020; 124:627-629. [PMID: 32188565 DOI: 10.1016/j.anai.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Caroline Foreman
- Medical HQ Glynde, Glynde, South Australia, Australia; The Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Thanh-Thao Adriana Le
- The Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua M Inglis
- The Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - William Bernard Smith
- The Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Yang RS, Zhang LK, Helmy R, Andreani T, Liu Z, Sheng H. Development of a highly efficient decontamination approach for ceftolozane in the pharmaceutical manufacturing environment. J Pharm Biomed Anal 2020; 177:112846. [PMID: 31522097 DOI: 10.1016/j.jpba.2019.112846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
Abstract
The β-lactam core is a key structure responsible for inducing both IgE-mediated acute-onset hypersensitivity and T-cell-mediated delayed-onset hypersensitivity with penicillins in humans. There is essentially no clinically significant immunologic cross-reactivity noted between the β-lactam cores of penicillins and cephalosporins based on challenge studies in humans. The side-chains appear to be more important in inducing IgE-mediated acute-onset hypersensitivity and T-cell delayed-onset hypersensitivity with cephalosporins in humans. Despite these clinical findings, the U. S. Food and Drug Administration (FDA) still requires the level of β-lactam-related antibiotic residues to be controlled at very low levels in manufacturing facilities. Ceftolozane is Merck & Co., Inc., Kenilworth, NJ, USA's (MSD's) 5th generation broad spectrum cephalosporin antibiotic against gram-negative bacteria. In searching for the optimal decontamination method of ceftolozane, most methods were found to be very slow in opening the β-lactam ring in ceftolozane. Moreover, most of the previously reported decontamination methods applied analytical methods that only monitored the disappearance of the parent molecule as the endpoint of degradation. In this way, many of the β-lactam-containing degradation products could be overlooked. In order to develop an efficient decontamination solution for ceftolozane, a sensitive ultra high performance liquid chromatography-high resolution-electrospray ionization-tandem mass spectrometry (UHPLC-HRMS/MS) method was first developed to ensure the detection of the β-lactam ring in all degradation products. Through online UHPLC-UV-HRMS monitoring, 2.5 N KOH in 50% aqueous MeOH or 50% aqueous EtOH was identified as the best condition to fully degrade the β-lactam ring in ceftolozane. This decontamination could be done within 15 min, even at 100 mg/mL concentration, and thus enable a quick turnaround time for equipment cleaning in the β-lactam manufacturing facility. This method was also successfully applied to 12 other commercially available β-lactam antibiotics.
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Affiliation(s)
- Rong-Sheng Yang
- Analytical Research and Development, Merck & Co., Inc., Kenilworth, NJ 07033, United States.
| | - Li-Kang Zhang
- Analytical Research and Development, Merck & Co., Inc., Kenilworth, NJ 07033, United States
| | - Roy Helmy
- Pharmacokinectis, Merck & Co., Inc., Kenilworth, NJ 07033, United States
| | - Teresa Andreani
- Small Molecule Process Research & Development, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - Zhijian Liu
- Small Molecule Process Research & Development, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - Huaming Sheng
- Analytical Science, Merck & Co., Inc., Rahway, NJ 07065, United States.
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Abstract
Penicillin allergies are not always lifelong. Approximately 50% are lost over five years A reaction to penicillin during a childhood infection is unlikely to be a true allergy Only 1–2% of patients with a confirmed penicillin allergy have an allergy to cephalosporins. In patients with a low risk of severe allergic reactions, cephalosporins are a relatively safe treatment option Patients with a history of delayed non-severe reactions, such as mild childhood rashes that occurred over 10 years ago, may be suitable for an oral rechallenge with low-dose penicillin. This should be done in a supervised hospital environment In many cases, with appropriate assessment and allergy testing, it may be possible to remove the penicillin allergy label
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Affiliation(s)
- Misha Devchand
- Antimicrobial Stewardship, Drug and Antibiotic Allergy Service and Centre for Antibiotic Allergy and Research, Austin Health, Melbourne.,Pharmacy Department, Austin Health, Melbourne.,The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne.,Department of Medicine, Austin Health, University of Melbourne
| | - Jason A Trubiano
- Antimicrobial Stewardship, Drug and Antibiotic Allergy Service and Centre for Antibiotic Allergy and Research, Austin Health, Melbourne.,Pharmacy Department, Austin Health, Melbourne.,The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne.,Department of Medicine, Austin Health, University of Melbourne
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Chaudhry SB, Veve MP, Wagner JL. Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity. PHARMACY 2019; 7:E103. [PMID: 31362351 PMCID: PMC6789778 DOI: 10.3390/pharmacy7030103] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022] Open
Abstract
Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1-3% of the population reporting a cephalosporin allergy. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite the low potential for cross-reactivity. The misdiagnosis of β-lactam allergies and misunderstanding of cross-reactivity among β-lactams, including within the cephalosporin class, often leads to use of broader spectrum antibiotics with poor safety and efficacy profiles and represents a serious obstacle for antimicrobial stewardship. Risk factors for cephalosporin allergies are broad and include female sex, advanced age, and a history of another antibiotic or penicillin allergy; however, cephalosporins are readily tolerated even among individuals with true immediate-type allergies to penicillins. Cephalosporin cross-reactivity potential is related to the structural R1 side chain, and clinicians should be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cephalosporins are brought to market. Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated. The purpose of this review is to provide an overview of the role of cephalosporins in clinical practice, and to highlight the incidence of, risk factors for, and cross-reactivity of cephalosporins with other antibiotics.
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Affiliation(s)
- Saira B Chaudhry
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA
- Department of Infectious Diseases, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Michael P Veve
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Knoxville, TN 37920, USA.
| | - Jamie L Wagner
- Department of Pharmacy Practice, School of Pharmacy, University of Mississippi, Jackson, MS 39216, USA
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