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Urticaria, angio-oedema and cross-reactivity: 2 case reports In a retrospective study involving 234 patients tested between 2013 and 2017 at a hospital in France, a 55-year-old woman and a 57-year-old man were described, who developed immediate hypersensitivity reactions (IHRs) in the form of urticaria and angiooedema during skin tests with amoxicillin and ceftriaxone or cefuroxime. The patients also exhibited cross reactivity between amoxicillin and ceftriaxone or cefuroxime [routes, dosages, times to reactions onsets and outcomes not stated]. Patient 44 from table E3: The 55-year-old woman, with a history of unspecified penicillin allergy, underwent a skin test (ST) with amoxicillin. She developed IHR in the form of acute urticaria and angio-oedema, indicative of positive penicillin allergy. Later, she underwent ST with cephalosporins; the cephalosporins were tested on different days, with a sequence of ceftriaxone, cefpodoxime and then cefuroxime. Monitoring was planned for 4 hrs for immediate response, and 7 days for delayed response after each test. She showed an immediate positive result to cefuroxime. However, ST and drug provocation test with cefpodoxime and ceftriaxone was negative. Thus, she was noted to have developed cross reactivity between amoxicillin and cefuroxime due to sensitisation to nuclear structures, additionally resulting in the positive skin tests. Patient 59 from table E3: The 57-year-old man, with a history of unspecified penicillin allergy, had atopic background in the form of allergic rhinoconjunctivitis. He underwent a skin test (ST) with amoxicillin, and he developed IHR presenting as acute urticaria and angio-oedema, indicative of positive penicillin allergy. Later, he underwent ST with cephalosporins; the cephalosporins were tested on different days, with a sequence of ceftriaxone, cefpodoxime and then cefuroxime. Monitoring was planned for 4 hrs for immediate response, and 7 days for delayed response after each test. He showed negative ST results with ceftriaxone, cefpodoxime and cefuroxime. Drug provocation test results with ceftriaxone and cefpodoxime showed an immediate positive result with acute urticaria to ceftriaxone, and negative result to cefpodoxime. Thus, he was noted to have developed cross reactivity between amoxicillin and ceftriaxone due to sensitisation to nuclear structures, also resulting in the positive skin tests. Chiron A, et al. Allergy to third- and second-generation cephalosporins in confirmed penicillin-allergic patients. Journal of Allergy and Clinical Immunology: In Practice 8: 803500863 2409-2411.e3, No. 7, Jul-Aug 2020. Available from: URL: http://doi.org/10.1016/j.jaip.2020.03.021

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Reactions 12 Sep 2020 No. 1821