The Medical Letter on Drugs and Therapeutics
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Cephalosporins for Patients with Penicillin Allergy

Only a small minority of patients who say they are allergic to penicillin will have a reaction if they take a penicillin.1

HISTORY OF ALLERGY — Patients with a history of an IgE-mediated reaction to a penicillin (urticaria, angioedema, bronchospasm, anaphylaxis) should be treated with a non-beta-lactam antibiotic or referred to an allergist for skin testing. The package inserts of first- and second-generation cephalosporins carry a warning of a 10% risk of cross-sensitivity in penicillin-allergic patients, but when patients with a history of severe reactions are excluded, the rate of reactions after giving a cephalosporin (without skin testing) to a patient with a history of penicillin allergy has been about 0.1%.2

BETA-LACTAM SIDE CHAINS — All penicillins and cephalosporins have a beta-lactam ring in common, ... more      

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