The Use of Cephalosporins in Penicillin-allergic Patients

A Literature Review

James D. Campagna, MD; Michael C. Bond; Esteban Schabelman; Bryan D. Hayes


J Emerg Med. 2012;42(5):612-620. 

In This Article

Materials and Methods

A literature search of MEDLINE (from 1950 to the present) was performed and limited to studies published in English. The search terms "penicillin$," "cephalosporin$," "allerg$," "hypersensitivity," and "cross-react$" were used ("$" indicates truncation, allowing for various endings). The terms were combined in the following search algorithm: "Penicillin$" AND "Cephalosporin$" AND ("Allerg$ as keyword" OR "Hypersensitivity, immediate or Drug hypersensitivity or Hypersensitivity, delayed or Hypersensitivity as subject heading or Hypersensitivity as keyword" OR "Cross reactions as subject heading OR cross react$ as keyword"). The titles and abstracts of the articles were screened, and articles determined to be appropriate for this review, based on their suspected relevance to the clinical question, were collected.

The search yielded 406 articles (Figure 1). Their abstracts and titles were assessed and reviewed by three of the authors. Fifty-five articles were deemed relevant to this review. To be selected, articles needed to specifically address the cross reactivity of cephalosporins in patients with a history of a penicillin allergy or, in laboratory studies, the cross reactivity of cephalosporins with penicillin antibodies. Examination of the reference lists led us to 12 additional articles, giving a total of 67. The set included two meta-analyses, 14 cohort studies (11 prospective and 3 retrospective), two surveys, and nine in vitro studies—a total of 27 articles that were included in this review (Table 1). The remaining 40 articles (reviews, letters to the editor, and background chemistry reports) were used as reference material but were not deemed applicable to the clinical question.

Figure 1.

Process for article selection. AAEM, American Academy of Emergency Medicine.

The 27 articles were evaluated for their level of evidence and methodology by at least two of the authors, using the literature review guidelines published by the American Academy of Emergency Medicine (Table 2, Table 3). If there was disagreement in the scoring, a third author reviewed the article. The major articles are summarized in Table 4.


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