Adverse Reaction to Ceftriaxone: How Far Can We Go to exclude an Allergy?
Benchidmi Sara
*
Division of Pediatric Immuno Allergology and Infectious Diseases, Ibn Sina University Hospital, Rabat, Morocco.
Aminou Sara
Division of Pediatric Immuno Allergology and Infectious Diseases, Ibn Sina University Hospital, Rabat, Morocco.
Jaabouti Ghizlan
Division of Pediatric Immuno Allergology and Infectious Diseases, Ibn Sina University Hospital, Rabat, Morocco.
Benchekroun Soumia
Division of Pediatric Immuno Allergology and Infectious Diseases, Ibn Sina University Hospital, Rabat, Morocco.
EL Hafidi Naima
Division of Pediatric Immuno Allergology and Infectious Diseases, Ibn Sina University Hospital, Rabat, Morocco.
Mahraoui Chafiq
Division of Pediatric Immuno Allergology and Infectious Diseases, Ibn Sina University Hospital, Rabat, Morocco.
*Author to whom correspondence should be addressed.
Abstract
In the pediatric population, cephalosporins are one of the most often prescribed antibiotic groups. Currently, the European Network for Drug Allergy's (ENDA) standardized diagnostic techniques are widely used to diagnose beta lactam allergic reactions, which help physicians to confirm or exclude the allergy.
Here, we report a case of an incorrectly labeled child of allergy to ceftriaxone after presenting a reaction minutes after the administration of the first dose of ceftriaxone. The allergic pathogenesis was suspected based on the clinical data (brief interval between the drug injection and the appearance of symptoms). we performed skin tests, intradermal tests (IDT) for ceftriaxone, which turn out negatives, then we found an alternative drug for the patient to use by testing ceftazidime and amoxicillin and finally, since the symptoms weren’t specific of an allergy reaction and more likely suggesting a vasovagal syncope, we pursued with an intravenous drug provocation test to ceftriaxone, those tests helped us to prove the innocence of ceftriaxone and enabled us to reassure the parents.
Doctors should be mindful of the risks associated with avoiding specific antibiotic classes, particularly beta lactams, which are the most frequently recommended first-line antibiotics for pediatric patients and whose exclusion may complicate the management of certain pathologies. Such an approach may increase the number of infections, have an influence on antimicrobial stewardship, and have negative health economic effects on the public, it is crucial to avoid identifying a child as allergic without first performing an appropriate diagnostic workup.
Keywords: Cephalosporin, ceftriaxone, allergy, skin test, drug provocation test
How to Cite
Downloads
References
Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, BlancaLopez N, et al. Drug hypersensitivity in children: Report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy. 2016;71: 149–161.
Vezir E, Erkocoglu M, Civelek E, Kaya A, Azkur D, Akan A, et al. The evaluation of drug provocation tests in pedi-atric allergy clinic: A single center experience. Allergy Asthma Proc. 2014; 35(2):156–62. Available:https://doi.org/10.2500 /aap.2014.35.3744
Macy E, Romano A, Khan D. Practical management of anti-biotic hypersensitivity in 2017. J Allergy Clin Immunol Pract. 2017;5(3):577–86. Available:https://doi.org/10.1016/j.jaip.2017.02.014
Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, et al. ENDA/EAACI Drug Allergy Interest Group. Skin test concentrations for systemically administered drugs— an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013 Jun;68(6): 702–12.
Muraro A, Worm M, Alviani C, Cardona V, Dunn Galvin A, Garvey LH, et al. European Academy of Allergy and Clinical Immunology, Food Allergy, Anaphylaxis Guidelines Group. EAACI guidelines: Anaphylaxis (2021 update). Allergy. 2022 Feb;77(2):357-377. DOI: 10.1111/all.1503 Epub 2021 Sep 1. PMID: 34343358.
Romano A, Gaeta F, Valluzzi RL, Maggioletti M, Zaffiro A, Caruso C, et al. IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of alternative cephalosporins. J Allergy Clin Immunol. 2015;136:685-91.e3.
Hasdenteufel F, Luyasu S, Renaudin JM, Trechot P, Kanny G. Anaphylactic shock associated with cefuroxime axetil: structure-activity relationships. Ann Pharmacother. 2007;41:1069-72.
Hasdenteufel F, Luyasu S, Hougardy N, Fisher M, Boisbrun M, Mertes PM, et al. Structure-activity relationships and drug allergy. Curr Clin Pharmacol. 2012;7:15-27.
Chaudhry Saira B, Veve Michael P, Wagner Jamie L. Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity. Pharmacy. 2019;7(3): 103 DOI: 10.3390/pharmacy7030103
Bousquet PJ, Gaeta F, Bousquet-Rouanet L, Lefrant JY, Demoly P, Romano A. Provocation tests in diagnosing drug hyper sensitivity. Curr Pharm Des. 2008;14(27): 2792-802. DOI: 10.2174/13816120878636973 PMID: 18991698.