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Frequency Low for Dual Allergy to Cefazolin, Natural Penicillins

TUESDAY, March 30, 2021 -- Though caution is warranted in patients with confirmed penicillin allergy or a history of severe allergic reactions, most patients with a penicillin allergy history who are undergoing surgical prophylaxis may safely receive cefazolin, according to a review published online March 17 in JAMA Surgery.

Bernardo Sousa-Pinto, M.D., Ph.D., from University of Porto in Portugal, and colleagues conducted a systematic literature review to identify studies that included patients who had index allergies to a natural penicillin and were tested for tolerability to cefazolin or that included patients who had index allergies to cefazolin and were tested for tolerability to a natural penicillin. The meta-analysis of data extracted from the studies selected for inclusion was used to estimate the frequency of allergic reactions.

Based on 77 identified studies (6,147 patients), the researchers found that cefazolin allergy was identified in 44 participants with a history of penicillin allergy, resulting in a meta-analytical frequency of dual allergy of 0.7 percent. The frequency of dual allergy was lower for participants with an unconfirmed penicillin allergy (0.6 percent) than for those with a confirmed penicillin allergy (3.0 percent). In 13 studies (3,884 patients) only examining surgical patients, 0.7 percent had a confirmed allergy to cefazolin. Penicillin allergy was confirmed in 16 patients with a history of cefazolin allergy, resulting in a meta-analytical frequency of dual allergy of 3.7 percent. Among the eight studies exclusively assessing surgical patients allergic to cefazolin, penicillin allergy frequency was 4.4 percent.

"The low frequency of penicillin-cefazolin dual allergy suggests that most patients should receive cefazolin regardless of penicillin allergy history," the authors write.

One author reported a patent for the Beta-Lactam Allergy Clinical Decision Support Tool licensed by Persistent Systems.

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