Anaphylaktische Reaktion auf Cefazolin bei guter Verträglichkeit von Penicillin, Amoxicillin und einzelnen anderen Cephalosporinen

Abstract

The problem of an allergy to penicillins and the possibility of related allergies to other β-lactams is very common and relevant in clinical practice. These antibiotics are often used to treat bacterial infection and to prevent endocarditis. Unlike allergic determinants derived from penicillin, the cephalosporin determinants have not been clearly identified yet. The question of a group allergy to β-lactams versus cross reactivity to single or all cephalosporins rises after IgE-mediated anaphylaxis to a β-lactam antibiotic, so further investigations are needed. We present an immediate-type hypersensitivity confirmed by positive in vitro diagnostic and skin tests in an 18-year-old woman who suffered from severe intraoperative anaphylaxis and generalized urticaria and angioedema within few minutes after intravenous administration of cefazolin. For premedication the patient had received amoxicillin before the elective surgery of talocrural join but hypersensitivity to this drug, in addition to latex, could be excluded. Prior to this anaphylaxis, cefazolin was well-tolerated, it was given several times during several heart catheterizations due to congenital atrioventricular septal defect. Allergologic investigations demonstrated additional sensitizations to cefotiam, cefuroxim and cefuroximaxetil, but tolerance to penicillin and amoxicillin in skin tests as well as in the oral challenge test. This case nicely demonstrates the complexity and need of a detailed allergologic work-up in suspected β-lactam hypersensitivity.