Abstract

ALMEIDA, José Pedro; SOARES, Joana; LOPES, Anabela  and  BARBOSA, Manuel Pereira. Selective hypersensitivity to cefazolin: Case séries. Rev Port Imunoalergologia [online]. 2014, vol.22, n.1, pp.55-58. ISSN 0871-9721.

Background: In the particular case of cefazolin, the selective hypersensitivity seems to be the preferential presentation and, for its parenteral use, reactions are often immediate and severe. The authors present a retrospective study of all cases of cefazolin hypersensitivity in the last 2 years. Case 1: 49 year-old woman with a past history of a generalized urticaria 3 hours following gastric banding surgery in 2008. Revisional band surgery was performed in 2009 with no adverse reaction. In 2012, anaphylaxis needing mechanical ventilation support was documented 15 minutes after anesthesia induction for gastric sleeve surgery. Common drugs used were rocuronium, propophol and cefazolin. Case 2: 36 year- old pregnant woman, who was submitted to epidural block with ropivacain and sufentanil; immediately after administration of cefazolin, oxytocin and ephedrine, a clinical picture of facial erythema, lips angioedema and hypotension was reported. Case 3: 66 year-old woman diagnosed with bilateral gonarthrosis with indication for surgical treatment; after epidural block with bupivacain and antibiotic prophylaxis with cefazolin, she suffered an anaphylactic shock with mechanical ventilation support need. Conclusion: The allergological investigation in three cases showed all the tests for culprit drugs were negative except for the intradermal test for cefalozin which was positive (immediate). Challenge tests performed were negative for the other culprit drugs. This selective hypersensitivity clinical reactivity pattern may be associated with the R1 side chain, which is known to be different in cefazolin when compared to other cephalosporins.

Keywords : Betalactam antibiotics; cefazolin; R1 side chain; selective hypersensitivity.

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