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Title Minimal Risk Of Severe Type 1 Hypersensitivity Reaction To Third Generation Cephalosporin In Patients Who Experience Type 1 Hypersensitivity Reaction And Allergy To Penicillin
Clinical Question Do patients who experience a severe type 1 hypersensitivity reaction to penicillin and demonstrate an allergy to cephalosporin experience a severe type 1 hypersensitivity reaction to the cephalosporin?
Clinical Bottom Line It appears that patients who have a severe type 1 hypersensitivity reaction to penicillin do not have an increased risk of anaphylaxis to cephalosporins. This evidence may be skewed however by adherence to the recommendation not to give cephalosporins to individuals with a history of penicillin anaphylaxis. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18159398Hameed/2002Focused on Children, but adult information also included.Systematic Review of Case Reports
Key resultsNo anaphylaxis to a cephalosporin has ever been reported in children, there have been 12 reports of anaphylaxis from cephalosporins in adults with a history of penicillin allergy or a positive penicillin skin test, but with no history of anaphylaxis from penicillin.
Evidence Search #2 Search Anaphylaxis and penicillin and cephalosporin and cross-reactivity
Comments on
The Evidence
The article used was a systematic review of case reports
Applicability The evidence is applicable to both adult and child patients with penicillin allergies.
Specialty/Discipline (Endodontics) (General Dentistry) (Oral Surgery) (Pediatric Dentistry) (Periodontics) (Prosthodontics)
Keywords Anaphylaxis, Penicillin, Cephalosporin, Cross-reactivity
ID# 848
Date of submission: 04/12/2011spacer
E-mail gruberj@livemail.uthscsa.edu
Author Joshua Gruber
Co-author(s) e-mail
Faculty mentor/Co-author Ernest Valdez, DDS
Faculty mentor/Co-author e-mail VALDEZE@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Julie Berkhoff (CO) on 08/04/2011
A more recent systematic review published in 2008 by the Journal of the American Pharmacists Association (PubMed: 18653431) confirmed a very low incidence of cross-reactivity based on oral re-challenge and skin testing to verify true allergic reaction vs non-allergic adverse reaction. This study included both animal and human studies.

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