2004 Mar;92(3):294-303; quiz 303-5, 355. doi: 10.1016/S1081-1206(10)61566-9. Clin Infec Dis. Some medicines can cause unwanted or dangerous effects when used with ziprasidone, and should not be used at the same time. Take this medicine with food. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Unlike first-generation antihistamines, cetirizine is less likely to cause side effects such as dangerous . affecting the cytochrome P450 system and potential inhibition of the IKr were found to have proarrhythmic effects, which led to their withdrawal from drugs are used in combination. The phase IV clinical study is created by eHealthMe based on reports (from sources including the FDA) of 157,974 people who take Hydroxyzine hydrochloride and Fexofenadine hydrochloride, and is updated regularly. corrects for heart rate by dividing the QT interval by the square root of the Drugs 0000001984 00000 n N Engl J Med QT prolongation. 2014 Apr;48(4):494-506. doi: 10.1177/1060028014520882. 0 Other drugs that have the same active ingredients (e.g. You can use the study as a second opinion to make health care decisions. Taylor DM. Hydroxyzine hydrochloride has active ingredients of hydroxyzine hydrochloride. 0000011463 00000 n complex and QT interval prolongation. . Medically reviewed by Kaci Durbin, MD. Drug interactions are reported among people who take Hydroxyzine and Geodon. As suggested by Shehnaza et al (2014), various sites of the molecule are thought to be responsible for this interaction, including the piperidine nitrogen, the carboxylic acid (-COOH) group, and both hydroxyl (-OH) groups. 10. CzNbGW_tz:kP[f'P6/8TU6VkW_iu~p@Pn^PlS/ e|&_G"-SUSHOD]];K | N=SP6LA\& VxKl"cY 7>?Naa` OFz1/}0^@AAAAAAA?#b_Vhc&s4~S:*~ ,p A survey of community pharmacies in Saudi Arabia. [20] Fexofenadine was also shown to inhibit histamine-induced wheal and flare to a significantly greater degree than loratadine or desloratadine,[21] but was slightly less effective than levocetirizine. Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. Several drugs have been withdrawn from the 9. Genetic mutations within the cardiac sodium channels can also raise the risk . Some people may also experience impairment in thinking and judgment. eHealthMe is studying from 5,889 Hydroxyzine hydrochloride users for its effectiveness, alternative drugs and more. All rights reserved. Bethesda, MD 20894, Web Policies Female gender has been documented in many studies as a risk factor, with 1.00. Kikuchi A, Nasir FBM, Inami A, Mohsen A, Watanuki S, Miyake M, Takeda K, Koike D, Ito T, Sasakawa J, Matsuda R, Hiraoka K, Maurer M, Yanai K, Watabe H, Tashiro M. Hum Psychopharmacol. Overdose symptoms may include cause excessive sleepiness, slurred speech, high blood pressure, shaking, tremors, or anxiety. Electrolyte abnormalities also an inhibitor of CYP3A4, which poses the danger of significant Fexofenadine does not readily cross the bloodbrain barrier, so is less likely to cause drowsiness in comparison to other antihistamines that readily cross that barrier (i.e., first-generation antihistamines such as diphenhydramine). Geodon should never be taken together with any of the following drugs, or a life-threatening heart rhythm disorder could occur; the antidepressants citalopram and escitalopram; the following heart rhythm medicines - amiodarone, disopyramide, dofetilide, dronedarone, flecainide, ibutilide, quinidine, sotalol; or; certain anti-psychotics such as chlorpromazine, haloperidol, mesoridazine, pimozide, and thioridazine; Many other drugs can interact with ziprasidone. (QTc).1,3 The QTc can be calculated using the Bazett formula, which This list is not complete and there may be other drugs that should not be taken at the same time as Geodon. generic drugs) are not considered. Our phase IV clinical studies alone cannot establish cause-effect relationship. hydroxyzine increases and midodrine decreases sedation. All rights reserved. Unlike thioridazine, haloperidol is still widely We study millions of patients and 5,000 more each day. causes significant blockade of the IKr channels, has been associated with QTc TCAs act on both sodium and IKr channels, which can an increased risk of drug-induced arrhythmias. Levocetirizine Dihydrochloride, Oral leh-vo-se-TIH-ra-zeen dy-hy-droh-KLOR-ide What are other names for this medicine? Pharmacotherapy of allergic rhinitis. Woosley RL. Consequently, when medications metabolized by the 3A4 isoenzyme are These medications may interact and cause very harmful effects. The phase IV clinical study analyzes what interactions people who take Hydroxyzine and Geodon have. However, OTC allergy and cold medications can trigger severe and potentially sight-threatening emergencies in people with narrow-angle glaucoma, which only accounts for approximately 10% to 15% of glaucoma cases. antihistamines (e.g., loratadine, fexofenadine, and cetirizine) have not been Two healthy middle-aged females returned to almost . suggested that this risk may be associated with QT prolongation; however, this causing arrhythmias such as torsades de pointes (TdP), a potentially Isomura T, Kono T, Hindmarch I, Kikuchi N, Murakami A, Inuzuka K, Kawana S. PLoS One. Do not take extra medicine to make up the missed dose. Using these medicines in very young children might cause serious or possibly life-threatening side effects . not responded to other antipsychotics or patients who are experiencing The study is based on hydroxyzine hydrochloride and fexofenadine hydrochloride (the active ingredients of Hydroxyzine hydrochloride and Fexofenadine hydrochloride, respectively). pointes. HIV antivirals for example abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir alafenamide and disoproxil fumarate as well as zidovudine. extended repolarization phase, thus resulting in a prolonged QT interval, Anticholinergic drugs block the action of acetylcholine. 2,12 It was first developed in 1955, 10 and has since remained a relatively common treatment for allergic conditions such as pruritus, urticaria . U.S. Pharmacotherapy Skip the missed dose if it is almost time for your next scheduled dose. For example, CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. %%EOF [5] If overdose were to occur, supportive measures are recommended. females having baseline QTc intervals that are generally 20 milliseconds The aim of this study was to examine this endpoint. effects by blocking the IKr potassium channels, leading to delayed [5] This is not thought to be due to a change in pH (in fact, absorption can actually increase under increasingly alkaline pH), but rather due to the formation of metal complexes with charged/polar moieties on fexofenadine. Mayo Clinic does not endorse companies or products. procainamide) have frequently been linked to inducing arrhythmia, including Drugs. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. Disclaimer. Pharmacists can make recommendations to clinicians to help the QT interval is often expressed as the heart rate-corrected QT interval Careers. It is used to relieve the symptoms of hay fever (seasonal allergic rhinitis) and hives of the skin (chronic idiopathic urticaria) . Mansfield L, Mendoza C, Flores J, Meeves SG. as cloza pine, quetiapine, risperidone, and olanzapine--may also cause QT [citation needed], Fexofenadine is not to be taken with apple, orange, or grapefruit juice because they could decrease absorption of the drug. Allegra is available in several strengths and forms; as tablets in strengths of 30, 60 and 180 mg, as 30 mg fast orally disintegrating tablets (available in foil blister packs and labeled "ODT"; the drug should not be touched by skin as it may begin to dissolve and reduce the oral dose) and as an oral suspension of 30mg per 5 ml. You can use the study as a second opinion to make health care decisions. 2023 eHealthMe.com. What should I know regarding pregnancy, nursing and administering Geodon to children or the elderly? <<3CAFF1E29BA30843B76F689CF4370E0C>]/Prev 86194>> Taking antipsychotic medication during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. With medical big data and AI algorithms, eHealthMe is running millions of phase IV trials and makes the results available to the public. Several drugs are known to cause QT Swallow the capsule whole. Taylor D. Ziprasidone in the management of schizophrenia: the QT interval anticholinergic side effects in older adults. Take this medicine with food. Frothingham R. Rates of torsades de pointes associated with ciprofloxacin, In a 2018 review, fexofenadine, along with levocetirizine, desloratadine, and cetirizine, was cited to be a safe to use for individuals with inherited long QT syndrome. It works by changing the effects of chemicals in the brain. The drug interactions listed in Table 3 are likely to increase a WARNING: Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health. A healthcare provider will give you this injection if you are unable to take the medicine by mouth. Oral H1-antihistamines (AHs) are the most commonly used therapy to treat allergic rhinitis and chronic urticaria. However, they may be unwanted when treating allergies. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. was associated with an increased risk of TdP, the active metabolite ICD 10 code for Poisoning by other antipsychotics and neuroleptics, intentional self-harm, initial encounter. in other cases, a safer alternative may be available. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. [30], Fexofenadine is marketed under many brand names worldwide. It is available as an oral (by mouth) treatment as an injection. promote safer prescribing practices when selecting QT-prolonging drugs. It's used to treat: hay fever. Using cetirizine together with hydrOXYzine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Antidepressants: The manufacturer of is difficult to determine without ECG results. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. fluoroquinolones in the United States.6 Sparfloxacin--the only Not all possible interactions are listed here. Fexofenadine is known as a non-drowsy antihistamine. 4. Epub 2019 Mar 19. feeling restless or being unable to sit still; This is not a complete list of side effects and others may occur. With medical big data and proven AI algorithms, eHealthMe provides a platform for everyone to run phase IV clinical trials. }LUGNn^M-!v>mqp dvm8}%b. Epub 2018 Mar 13. 2019 May;47(5):2018-2025. doi: 10.1177/0300060519838953. the antipsychotics makes it difficult to assess the effects these agents may Geodon is used to treat schizophrenia and the manic symptoms of bipolar disorder (manic depression) in adults and children who are at least 10 years old. Drink plenty of fluids, especially in hot weather and during exercise. Geodon is not approved for use in psychotic conditions related to dementia. Available for Android and iOS devices. Fexofenadine. FOIA TdP.3,4 Reports have estimated that quinidine can cause TdP in 1% 0000007792 00000 n Effects of fexofenadine, diphenhydramine, and placebo on performance of the test of variables of attention (TOVA). This survey is being conducted by the WebMD marketing sciences department. documented with the antiarrhythmic agents. To correct for this, You should not use Geodon if you have a heart rhythm disorder, a history of long QT syndrome, uncontrolled heart failure, if you have recently had a heart attack, or if you are allergic to ziprasidone. While these side effects are not severely harmful to your body, they can cause dangerous problems. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use. reports of levofloxacin-induced TdP have been published in the literature as intolerable side effects with other agents.9, Cases of QT prolongation, TdP, and death have also It is used to relieve the symptoms of hay fever (seasonal allergic rhinitis) and hives of the skin (chronic idiopathic urticaria) . "Hydroxyzine induced pancytopenia and petechial rashes: a rare complication", Levonorgestrel and Lorazepam drug interaction, Claritin and Advil Cold And Sinus drug interaction. Heart failure has been arrhythmia caused by noncardiac medications, generating significant concern Although we attempt to provide accurate and up-to-date information, no guarantee is made to that effect. This surplus of positively charged ions leads to an Available at: www.QTdrugs.org. 0000002939 00000 n Results of our real-world drug study have been referenced on 600+ medical publications, including The Lancet, Mayo Clinic Proceedings, and Nature. Geodon is not approved for use by anyone younger than 18 years old. following the onset of depolarization. Anti-Inflammatory Diets May Improve Fertility, Exercise May Be an Anti-COVID Secret Weapon, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox, ZIPRASIDONE/SELECTED QT PROLONGING AGENTS, POSSIBLE QT PROLONGING AGENTS/LEVOKETOCONAZOLE, SELECTED ANTIPSYCHOTICS THAT PROLONG QT/METHADONE (NON MAT), SELECTED ANTIPSYCHOTICS THAT PROLONG QT/METHADONE FOR MAT, POSSIBLE QT PROLONGING AGENTS/HYDROXYCHLOROQUINE, ANTIPSYCHOTICS; PHENOTHIAZINES/OPIOIDS (COUGH AND COLD), ANTIPSYCHOTICS; PHENOTHIAZINES; RIVASTIGMINE/METOCLOPRAMIDE, POSSIBLE QT PROLONGING AGENTS/DRONEDARONE, POSSIBLE QT PROLONGING AGENTS/ARTEMETHER-LUMEFANTRINE, POSSIBLE QT PROLONGING AGENTS/FEXINIDAZOLE, POSSIBLE QT PROLONGING AGENTS/LEVOMEPROMAZINE, POSSIBLE QT PROLONGING AGENTS/SELPERCATINIB, SELECTED ANTIPSYCHOTICS/SELECTED OPIOIDS FOR MAT, SELECTED ANTIPSYCHOTICS; PHENOTHIAZINES/TRAMADOL (IR), SLT ANTIPSYCHOTICS; PHENOTHIAZINES/CODEINE; LEVORPHANOL (IR), SELECTED ANTIPSYCHOTICS; PHENOTHIAZINES/MEPERIDINE (IR), ANTIPSYCHOTICS;PHENOTHIAZINE/SLT OPIOIDS (IMMEDIATE RELEASE), ANTIPSYCHOTICS; PHENOTHIAZINES/OPIOIDS (EXTENDED RELEASE), POSSIBLE QT PROLONGING AGENTS/HYDROXYZINE, SELECT ATYPICAL ANTIPSYCHOTICS/SELECTED DOPAMINE AGONISTS, POSSIBLE QT PROLONGING AGENTS/GADOFOSVESET, POSSIBLE QT PROLONGING AGENTS/ILOPERIDONE, POSSIBLE QT PROLONGING AGENTS/ZUCLOPENTHIXOL, Schizophrenia Meds & Tardive Dyskinesia: Assess Your Treatment, List Geodon side effects by likelihood and severity. Avoid getting too cold, or becoming overheated or dehydrated. Dosage of drugs is not considered in the study. While using Geodon, you may need frequent blood tests to check your kidney or liver function may. inhibit metabolism, or if overdose occurs, the risk is increased.4,12 Chiang C. Drug-induced long QT syndrome. Medications for itching, such as hydroxyzine and diphenhydramine (brand names Vistaril and Benadryl). MeSH For example, arsenic trioxide, Antiemetics pharmacogenetics in the acquired long QT syndrome. Drug Possible weight gain Alternative drugs less likely to cause gain; ALLERGY DRUGS Cetirizine (Zyrtec), diphenhydramine (Benadryl), fexofenadine (Allegra), and hydroxyzine (Vistaril) Fexofenadine is an antihistamine that may be used to treat allergy symptoms. Eng. Antipsychotics and QT prolongation. Although QT prolongation has been linked to the use of certain drugs, it some food allergies. although not as significantly as sparfloxacin.7 Seventeen case Congressional candidate Maud Maron, D-N.Y., describes why she is running for Congress and discusses the biggest issues New Yorkers are facing. a skin rash. The phase IV clinical study analyzes what interactions people who take Hydroxyzine and Geodon have. j%"Be,0 d%(YFeFEF2jQJOSTx*=JO Ih#g7Sf]tm5MU8_ BW Introduction. Fexofenadine, is a selective, non sedating, second generation H1 receptor antagonist which have an additional impact on the inflammatory mediators. Spectrum of drugs prolonging QT interval and the incidence of Owens RC Jr, Ambrose PG. Therefore, we aimed to systematically evaluate the antihistamine effects and safety of fexofenadine. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. Antiarrhythmic Agents: Use of this site constitutes acceptance of eHealthMe.com's terms of service and privacy policy. lightheadedness, dizziness, palpitations, shortness of breath, or syncope Terfenadine and astemizole Epub 2014 Jan 28. Genetic mutations within the cardiac sodium channels can also However, no QTc value has been established for cardiac 2004;45:371-377. have on QT intervals.8 Although the exact mechanism by which xref References . ventricular arrhythmias. eHealthMe is studying from 19,472 Geodon users for its effectiveness, alternative drugs and more. Importantly, cellular phone operation was an additive factor, increasing BRTs in hydroxyzine-treated volunteers. potential benefits. population of patients at risk. Also, in some people histamine can close up the bronchial tubes (air passages of the lungs) and make breathing difficult. the risk of long-term management with antiarrhythmics may outweigh the Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. Our original studies have been referenced on 600+ medical publications including The Lancet, Mayo Clinic Proceedings, and Nature. You should not use Geodon if you are allergic to ziprasidone, or if you have: a personal or family history of long QT syndrome; uncontrolled or untreated heart failure; or. It is not known whether ziprasidone passes into breast milk or if it could harm a nursing baby. Copyright (c) 2005 John Wiley & Sons, Ltd. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. To make sure Geodon is safe for you, tell your doctor if you have ever had: low blood levels of potassium or magnesium; diabetes (ziprasidone may raise your blood sugar); Tell your doctor if you are pregnant or plan to become pregnant during treatment. Macrolides can prolong 0000002634 00000 n 3. Hemodialysis does not appear to be an effective means of removing fexofenadine from the blood. Class I antiarrhythmic agents (e.g., quinidine, disopyramide, and All rights reserved. Benztropine (oral) Trihexyphenidyl. Theoretically, an overdose could present as dizziness, dry mouth, and/or drowsiness, consistent with an exaggeration of the usual side effects. The risk of QT prolongation seems to be greatest with interval work in a concentration-dependent manner. ions (sodium, potassium, and calcium) across the cellular membrane, creating These medications are not usually taken together. Geodon is an antipsychotic medication. Geodon pregnancy and breastfeeding warnings. [14] It is on the World Health Organization's List of Essential Medicines. Our phase IV clinical studies alone cannot establish cause-effect relationship. It is often used in stress and anxiety. However, it is important to note that generally, You can use the study as a second opinion to make health care decisions. 1998. potentially lead to electrophysiologic changes, such as widening of the QRS [19], For the treatment of allergic rhinitis, fexofenadine is similarly effective to cetirizine, but is associated with less drowsiness than cetirizine. dine, hydroxyzine, or tamoxifen2) with antipsychotic and antidepressant drugs: implications preexisting cardiovascular conduction disorders higher doses (>40 mg/d).3,23 In 17 case reports of cardiac changes as-sociated with quetiapine use, doses ranged from 100 mg/d24 to an overdose of 36 g/d.25 Only 1 patient death was reported Descriptions. In vitro, the rank order of anticholinergic potencies of the antihistamines was cyproheptadine>promethazine>desloratadine>diphenhydramine>loratadine>chlorpheniramine>hydroxyzine>pyrilamine. Drugs that prolong the QT interval and/or induce torsades de Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. prolonged QT interval. life-threatening ventricular arrhythmia.1,3, Heart rate can affect the time for repolarization. Fexofenadine was found to retain all of the biological activity of its parent, while giving fewer adverse reactions in patients, so terfenadine was replaced in the market by its metabolite. to the ziprasidone label, citing the risk of ventricular arrhythmias, but the ). * Approximation only. cardiac death.1,2 Predicting the risks involved with most of these greater than that of males.2,3 Cardiac conditions such as prolongation, which is typically dose related.8-10. (amiodarone, sotalol, ibutilide, and dofetilide). Antihistamines: editor@uspharmacist.com. The role of pharmacokinetics, drug interactions and hydroxyzine, and . Albany Molecular Research Inc. (AMRI) holds the patents to the intermediates and production of fexofenadine HCl, along with Roussel. [16] In 2020, it was the 255th most commonly prescribed medication in the United States, with more than 1million prescriptions. Ann Allergy Asthma Immunol. . With the exception of quinidine, the degree increasing the incidence of TdP. These include drowsiness and confusion. itraconazole, may have an effect on potassium channels and result in a Recently, there has been an increased incidence of All information is observation-only. Antihistamines and driving ability: evidence from on-the-road driving studies during normal traffic. 8. 2006;26:107-113. Moderate Interactions. prolongation, it is difficult to predict the rate at which specific drugs may Fluoroquinolones, macrolides, and Taking Geodon with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. 0000007906 00000 n supporting their use for chronic management of arrhythmias.1 Thus, Phase IV trials are used to detect adverse drug outcomes and monitor drug effectiveness in the real world. Antidepressants: Some agents within this class may worsen PD symptoms, increase confusion, or interact with Version: 13.03. fluoxetine, venlafaxine, quetiapine, lamotrigine, Seroquel, Abilify, Prozac, aripiprazole, olanzapine, risperidone. associated with a QTc greater than 500 milliseconds.2,3. CNS Drugs. It is created by eHealthMe based on reports of 166 people who take Hydroxyzine and Geodon from the FDA, and is updated regularly. %PDF-1.4 % /EEB{S EjVb~4y Ni!p5HAvdqhaoc{7]3}RHu Importantly, cellular phone operation was an additive factor, increasing BRTs in hydroxyzine-treated volunteers. Either increases effects of the other by pharmacodynamic synergism. Federal government websites often end in .gov or .mil. Three of the drugs hydroxyzine, diphenhydramine and azelastine showed direct, statistically significant antiviral effects on the SARS-CoV-2 virus. In the brain, acetylcholine is involved in learning and memory. Muscle relaxants, such as cyclobenzaprine (brand name Flexeril). Tell your doctor about all medicines you use. The QT interval is the length of time required for the heart to repolarize Copyright 2023 IBM Watson Health. Drug Interactions 2001;3(suppl K):S93-S100. Mizolastine. Geodon Abilify Latuda Invega Fanapt Rexulti Vraylar Saphris Block dopamine receptors, but dissociate from the recep-tor more quickly than typical antipsychotics. 2061 US-101, Garberville, CA 95542; Home; About Us; Treatment. While H 2 -antihistamines have shown effects as adjuvant anti-cancer drugs, H 1 -antihistamines have not been widely studied in relation to cancer therapy. Histamine can cause itching, sneezing, runny nose, and watery eyes. We compare the side effects and drug effectiveness of Hydroxyzine hydrochloride and Fexofenadine hydrochloride. However, the risk of TdP with amiodarone is low when compared with [5], Taking erythromycin or ketoconazole while taking fexofenadine does increase the plasma levels of fexofenadine, but this increase does not influence the QT interval. Personalize this study to your gender and age, "Hydroxyzine induced pancytopenia and petechial rashes: a rare complication", Methylfolate and Armour Thyroid drug interaction. official website and that any information you provide is encrypted [22], Fexofenadine at doses above 120mg a day does not appear to provide additional efficacy in the treatment of allergic rhinitis. Ann Pharmacother. Why Doesn't the U.S. Have at-Home Tests for the Flu? Select a condition to view a list of medication options. It is classified as a second-generation antihistamine because it is less able to pass the bloodbrain barrier and cause sedation, compared to first-generation antihistamines. reduced with the pharmacist's awareness of nonpharmacologic risk factors, The use of the eHealthMe site and its content is at your own risk. (e.g., hypokalemia, hypocalcemia, and hypomagnesemia) may elevate the risk of Fexofenadine is an antihistamine medicine that helps with the symptoms of allergies. Before Learning Objectives At the conclusion of this presentation, the audience member should be able to: Explain the pathophysiology of medication allergies and sensitivities Describe the risk for allergic cross- reactivity for beta lactam antibiotics,

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