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Cátia Alves1, Ana Margarida Romeira1, Paula Leiria Pinto1

1-Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa

Congress of the European Academy Allergology Clinical Immunology - Poster

Cephalosporins are widely used to prevent infections in patients undergoing surgery. The use, and overuse, of these drugs has been associated with adverse drug reactions. Concerning cefazolin, the selective hypersensitivity seems to be the preferential presentation and, for its parenteral use, reactions are often immediate and severe.
Case reports
The authors present 4 cases of perioperative anaphylaxis, during surgical procedures in which cefazolin was used.
Case 1 – 13 year-old girl with a history of traumatic cubitus varus. Anaphylactic shock appeared after administration of cefazolin, midazolam, sufentanil, propofol, atracurium, thiopental and sevoflurane; IDT was positive for cefazolin. Amoxicillin was identified as alternative, after drug provocation test (DPT).
Case 2 – 30 year-old woman with diagnosis of breast cancer. She had an anaphylactic shock after the use of midazolam, fentanyl, propofol, rocuronium and cefazolin. IDT was positive to cefazolin. Diagnostic investigation was negative for the other drugs used during the procedure. Amoxicillin/clavulanate was identified as alternative, after DPT.
Case 3 – 12 years-old boy diagnosed with paraphimosis; an anaphylactic reaction developed after administration of  midazolam, alfentanil, propofol, sevoflurane, paracetamol, ketorolac and cefazolin. Cefazolin SPT was negative and the IDT doubtful (erythema of the papule but without an increase in size). The patient refused a drug provocation test with cefazolin.
Case 4 50 year-old woman with patent foramen ovale; during a cardiac procedure, anaphylaxis was developed after administration of cefazolin, alfentanil, midazolam, propofol and neostigmine; skin prick test (SPT) and intradermic test (IDT) were negative for cefazolin; IDT was positive for penicillin and amoxicillin/clavulanate.
Cefazolin immediate hypersensitivity is uncommon; reactions are often severe, immediate-type, with elevated proportion of anaphylactic shock, anaphylaxis, urticaria/angioedema. This can be partly explained by the route of administration. A complete diagnostic workup is necessary to have a clear diagnosis and to identify an antibiotic alternative when the patient has allergy to cefazolin. In the literature, we find that many patients with allergy to cefazolin tolerate amoxicillin. In our patients, that was also verified in two of them. Of the other two, one has refused the investigation and in the other this workup was not concluded.

Palavras Chave: drug hypersensitivity; cefazolin