Campagna James D, Bond Michael C, Schabelman Esteban, Hayes Bryan D
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
J Emerg Med. 2012 May;42(5):612-20. doi: 10.1016/j.jemermed.2011.05.035. Epub 2011 Jul 13.
The practice of avoiding cephalosporin administration to penicillin-allergic patients persists despite the low rate of cross reactions between both groups of antibiotics.
The purpose of this literature review is to evaluate the published evidence regarding the commonly held belief that patients with a history of an allergic reaction to penicillin have a significantly increased risk of an allergic reaction to cephalosporins.
Articles were identified through a computerized search of MEDLINE from 1950 to the present using the search terms "penicillin$," "cephalosporin$," "allerg$," "hypersensitivity," and "cross-react$." All articles were reviewed, and additional sources cited in them were added to the literature review.
Penicillins have a cross allergy with first-generation cephalosporins (odds ratio 4.8; confidence interval 3.7-6.2) and a negligible cross allergy with second-generation cephalosporins (odds ratio 1.1; confidence interval 0.6-2.1). Laboratory and cohort studies confirm that the R1 side chain is responsible for this cross reactivity. Overall cross reactivity between penicillins and cephalosporins is lower than previously reported, though there is a strong association between amoxicillin and ampicillin with first- and second-generation cephalosporins that share a similar R1 side chain.
Although a myth persists that approximately 10% of patients with a history of penicillin allergy will have an allergic reaction if given a cephalosporin, the overall cross-reactivity rate is approximately 1% when using first-generation cephalosporins or cephalosporins with similar R1 side chains. However, a single study reported the prevalence of cross reactivity with cefadroxil as high as 27%. For penicillin-allergic patients, the use of third- or fourth-generation cephalosporins or cephalosporins with dissimilar side chains than the offending penicillin carries a negligible risk of cross allergy.
尽管两类抗生素之间的交叉反应发生率较低，但对青霉素过敏的患者仍一直避免使用头孢菌素。
本综述的目的是评估已发表的证据，以验证普遍持有的观点，即有青霉素过敏史的患者对头孢菌素过敏的风险显著增加。
通过计算机检索1950年至今的MEDLINE数据库，使用检索词“青霉素$”“头孢菌素$”“过敏$”“超敏反应”和“交叉反应$”来识别文章。对所有文章进行了审查，并将其中引用的其他来源纳入文献综述。
青霉素与第一代头孢菌素有交叉过敏反应（优势比4.8；置信区间3.7 - 6.2），与第二代头孢菌素的交叉过敏反应可忽略不计（优势比1.1；置信区间0.6 - 2.1）。实验室和队列研究证实，R1侧链是这种交叉反应的原因。青霉素和头孢菌素之间的总体交叉反应率低于先前报道的水平，尽管阿莫西林和氨苄西林与具有相似R1侧链的第一代和第二代头孢菌素有很强的关联。
尽管一直存在一种误解，即约10%有青霉素过敏史的患者使用头孢菌素时会发生过敏反应，但使用第一代头孢菌素或具有相似R1侧链的头孢菌素时，总体交叉反应率约为1%。然而，一项研究报告称，头孢羟氨苄的交叉反应发生率高达27%。对于青霉素过敏的患者，使用第三代或第四代头孢菌素或与引起过敏的青霉素侧链不同的头孢菌素，交叉过敏的风险可忽略不计。
