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Title: Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes
Authors: Bogas, Gador
Mayorga, Cristobalina
Martín-Serrano, Ángela
Fernández-Santamaría, Rubén
Jiménez-Sánchez, Isabel M.
Ariza, Adriana
Barrionuevo, Esther
Posadas, Teresa
Salas, María
Fernández, Tahía Diana
Torres, María José
Montañez, María Isabel
metadata.dc.contributor.authoraffiliation: [Bogas,G; Mayorga,G; Martín-Serrano,A; Fernández-Santamaría,R; Jiménez-Sánchez,IM; Ariza,A; Barrionuevo,E; Posadas,T; Salas,M; Fernández,TD; Torres,MJ; Montañez,MI] Allergy Research Group, Instituto de Investigación Biomédica de Málaga- IBIMA, Hospital Civil, Málaga, Spain. [Bogas,G; Mayorga,G; Barrionuevo,E; Posadas,T; Salas,M; Torres,MJ] Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain. [Mayorga,G; Martín-Serrano,A; Jiménez-Sánchez,IM; Torres,MJ; Montañez,MI] Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain. [Fernández,TD] Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, Málaga, Spain. [Torres,MJ] Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, Málaga, Spain.
Keywords: Amoxicillin;Betalactam;Cephalosporin;Cross-reactivity;Drug allergy;Antigenic determinant;Specific IgE;Amoxicilina;Beta-lactamas;Cefalosporinas;Hipersensibilidad a las Drogas;Reacciones cruzadas;Epítopos;Inmunoglobulina E
metadata.dc.subject.mesh: Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Penicillins::Penicillin G::Ampicillin::Amoxicillin
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Cephalosporins
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams
Medical Subject Headings::Phenomena and Processes::Immune System Phenomena::Immune System Processes::Antigen-Antibody Reactions::Cross Reactions
Medical Subject Headings::Diseases::Immune System Diseases::Hypersensitivity::Drug Hypersensitivity
Medical Subject Headings::Chemicals and Drugs::Biological Factors::Antigens::Epitopes
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Globulins::Serum Globulins::Immunoglobulins::Antibodies::Immunoglobulin Isotypes::Immunoglobulin E
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Issue Date: 4-Dec-2020
Publisher: BioMed Central (BMC), Springer Nature
Citation: Bogas G, Mayorga C, Martín-Serrano Á, Fernández-Santamaría R, Jiménez-Sánchez IM, Ariza A, et al. Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes. Clin Transl Allergy. 2020 Dec 4;10(1):57
Abstract: Background Analysis of cross-reactivity is necessary for prescribing safe cephalosporins for penicillin allergic patients. Amoxicillin (AX) is the betalactam most often involved in immediate hypersensitivity reactions (IHRs), and cefadroxil (CX) the most likely cephalosporin to cross-react with AX, since they share the same R1 side chain, unlike cefuroxime (CO), with a structurally different R1. We aimed to analyse cross-reactivity with CX and CO in patients with confirmed IHRs to AX, including sIgE recognition to AX, CX, CO, and novel synthetic determinants of CX. Methods Fifty-four patients with confirmed IHRs to AX based on skin test (ST) and/or drug provocation test (DPT) were included. Serum sIgE to AX and benzylpenicillin was determined by Radioallergosorbent test (RAST). Two potential determinants of CX, involving intact or modified R1 structure, with open betalactam ring, were synthesised and sIgE evaluated by RAST inhibition assay. Results Tolerance to CX (Group A) was observed in 64.8% cases and cross-reactivity in 35.2% cases (Group B). Cross-reactivity with CO was only found in 1.8% cases from Group B. ST to CX showed a negative predictive value of 94.6%. RAST inhibition assays showed higher recognition to CX as well as to both synthetic determinants (66% of positive cases) in Group B. Conclusions Cross-reactivity with CX in AX allergic patients is 35%, being ST not enough for prediction. R1, although critical for recognition, is not the unique factor. The synthetic determinants of CX, 1-(HOPhG-Ser-Bu) and 2-(pyrazinone) are promising tools for determining in vitro cross-reactivity to CX in AX allergic patients. Background Betalactams (BLs) are the drugs most frequently involved in immediate (IgE-mediated) hypersensitivity reactions (IHRs) [1,2,3], which could be explained by their ability to act as haptens due to their high chemical reactivity against proteins [4, 5]. BL chemical structure is formed by a 4-membered ring (the so-called BL ring) that in penicillins is fused to a 5-membered thiazolidine ring, and in cephalosporins to a 6-membered dihydrothiazine ring (Fig. 1). These drugs have a side chain (R1) bound to the BL ring; besides, cephalosporins have a second side chain (R2) bound to the dihydrothiazine ring, whose chemical structures distinguish the different compounds [6, 7].
metadata.dc.identifier.doi: 10.1186/s13601-020-00368-1
ISSN: 2045-7022 (Online)
Appears in Collections:01- Artículos - BIONAND - Centro Andaluz de Nanomedicina y Biotecnología
01- Artículos - Hospital Regional de Málaga
01- Artículos - IBIMA. Instituto de Investigación Biomédica de Málaga

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