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Comment & Response
August 25, 2021

Dual Allergy to Penicillin and Cefazolin—Does Anaphylaxis Matter?—Reply

Author Affiliations
  • 1Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
  • 2University of Colorado Hospital, Aurora
  • 3Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
  • 4Center for Health Technology and Services Research, University of Porto, Porto, Portugal
  • 5Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal
  • 6Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
  • 7Harvard Medical School, Boston, Massachusetts
  • 8The Mongan Institute, Massachusetts General Hospital, Boston
JAMA Surg. 2021;156(12):1184-1185. doi:10.1001/jamasurg.2021.3761

In Reply Mraovic et al disagree with the recommendation to administer cefazolin for prophylaxis of surgical site infections to patients with a history of penicillin allergy, asserting that the risk of severe anaphylaxis is too great. This recommendation is based on the difference in frequency of dual cefazolin-penicillin allergy between patients with confirmed penicillin allergy (3.0%) and patients with unconfirmed penicillin allergy (0.6%).1 We acknowledge the risk of hypersensitivity to cefazolin is indeed greater for patients with confirmed penicillin allergies, but we suggest this greater risk may not be entirely specific to cefazolin but to the patient population with drug allergies.

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