Miranda A, Blanca M, Vega J M, Moreno F, Carmona M J, García J J, Segurado E, Justicia J L, Juarez C
Allergy Section, Carlos Haya Hospital, Málaga, Spain.
J Allergy Clin Immunol. 1996 Sep;98(3):671-7. doi: 10.1016/s0091-6749(96)70101-x.
The cross-reactivity between penicillins and cephalosporins can be influenced by different factors, which are not all well known. The chemical structure of the side chain may contribute to the cross-reactivity.
The study was carried out in allergic subjects who are selectively responsive to amoxicillin to determine allergenic cross-reactivity with a cephalosporin containing a side chain identical to that of amoxicillin, cefadroxil, and one containing a different side chain, cefamandole.
Allergic subjects with a selective response to amoxicillin were chosen according to the following criteria: history of an immediate allergic reaction to amoxicillin, negative skin test responses to benzylpenicilloyl and minor determinant mixture of benzylpenicillin, negative RAST response to benzylpenicilloyl, and good tolerance to benzylpenicillin and phenoxymethyl penicillin challenges. In addition, subjects had to have a positive skin test response to amoxicillin and/or positive RAST response to amoxicilloyl or, if these test results were negative, a positive challenge test response to amoxicillin. In vivo cross-reactivity to cefadroxil was assessed by giving oral cefadroxil at increasing doses from 5 to 500 mg. In vitro cross-reactivity was determined by RAST inhibition studies with amoxicilloyl RAST disks and the following monomeric conjugates in the fluid phase: amoxicillin-butylamine, cefadroxil-butylamine, and the side chain para-hydroxy-phenylglycine. Tolerance to cefamandole was determined by giving 100 mg and then 500 mg parenterally.
Twenty-one patients with a selective response to amoxicillin were included in the study. Eight subjects (38%) had a positive response to cefadroxil, and none reacted to cefamandole. In vitro RAST inhibition studies indicated that cefadroxil-butylamine monomers cross-reacted with amoxicillin butylamine and the side chain contributed relevantly to the inhibition.
These results indicate that the percentage of cross-reactivity between penicillins and cephalosporins with an identical side chain is high and that this critical part of the molecule seems to be an important contributor to these results. The value is higher than previously reported data from similar studies of non-side-chain-related cephalosporins.
青霉素和头孢菌素之间的交叉反应性可能受到不同因素的影响，而这些因素并非都为人熟知。侧链的化学结构可能会导致交叉反应性。
在对阿莫西林有选择性反应的过敏受试者中开展研究，以确定与一种含有与阿莫西林相同侧链的头孢菌素（头孢羟氨苄）以及一种含有不同侧链的头孢菌素（头孢孟多）之间的变应原交叉反应性。
根据以下标准选择对阿莫西林有选择性反应的过敏受试者：有对阿莫西林速发型过敏反应的病史、对苄青霉素酰和苄青霉素次要决定簇混合物皮肤试验反应阴性、对苄青霉素酰放射变应原吸附试验（RAST）反应阴性，以及对苄青霉素和苯氧甲基青霉素激发试验耐受性良好。此外，受试者必须对阿莫西林皮肤试验反应阳性和/或对阿莫西林酰RAST反应阳性，或者，如果这些试验结果为阴性，则对阿莫西林激发试验反应阳性。通过口服剂量从5毫克递增至500毫克的头孢羟氨苄来评估对头孢羟氨苄的体内交叉反应性。通过使用阿莫西林酰RAST盘以及以下液相中的单体结合物进行RAST抑制研究来确定体外交叉反应性：阿莫西林-丁胺、头孢羟氨苄-丁胺以及侧链对羟基苯甘氨酸。通过静脉注射100毫克然后500毫克来确定对头孢孟多的耐受性。
21名对阿莫西林有选择性反应的患者纳入了研究。8名受试者（38%）对头孢羟氨苄反应阳性，对头孢孟多均无反应。体外RAST抑制研究表明，头孢羟氨苄-丁胺单体与阿莫西林丁胺交叉反应，且侧链对抑制作用有显著贡献。
这些结果表明，具有相同侧链的青霉素和头孢菌素之间的交叉反应性百分比很高，并且该分子的这一关键部分似乎是导致这些结果的重要因素。该数值高于先前关于非侧链相关头孢菌素的类似研究报告的数据。
