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Title: Testing Strategies and Predictors for Evaluating Immediate and Delayed Reactions to Cephalosporins.
Austin Authors: Stone, Cosby A;Trubiano, Jason A ;Phillips, Elizabeth J
Affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, WA, Australia
Infectious Diseases
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn
Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tenn
National Centre for Infections in Cancer and Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
Department of Medicine, University of Melbourne, Parkville, VIC, Australia
Centre for Antibiotic Allergy and Research
Issue Date: 19-Aug-2020 2020-08-19
Publication information: The Journal of Allergy and Clinical Immunology. In Practice 2020; online first: 19 August
Abstract: Although 1% to 2% of the general population carries a cephalosporin allergy label (CAL), we lack validated testing strategies and predictors of true allergy. To identify cross-reactivity patterns and predictors of skin test positive (STP) in geographically disparate patients with a CAL. A total of 780 adult patients labeled with a CAL or penicillin allergy label (PAL) with unknown tolerance of cephalosporins identified from the Austin Hospital (Melbourne, Australia) (n = 410) and Vanderbilt University Medical Center (Nashville, TN) (n = 370) between 2014 and 2018 underwent a standardized skin testing. Of 328 patients with a CAL, 29 (8.8%) tested STP to ≥1 cephalosporin(s). There were no cefazolin or ceftriaxone STP, 0 of 452 (0%), in patients with a PAL only. Of 328 patients with a CAL, 16 (4.8%) were ampicillin STP. Eleven of 16 of these patients had an initial allergy label to cephalexin. Twenty of 29 cephalosporin STP patients demonstrated tolerance to a cephalosporin with a different R1 side chain, and 8 of 14 ampicillin STP patients demonstrated tolerance to ≥1 non-amino R1 group cephalosporin. Eleven of 13 patients STP to cefazolin were skin and ingestion challenge negative to all other penicillins and cephalosporins predicted by its distinct R1/R2 groups. Seven of 15 ceftriaxone STP patients demonstrated cross-reactivity with R1-similar cephalosporins. Time since the original reaction predicted STP testing to both penicillins, adjusted odds ratio (aOR) per year 0.93 (95% confidence interval [CI]: 0.90, 0.97), and cephalosporins, aOR per year 0.71 (95% CI: 0.56, 0.90). Cephalosporin cross-reactivity is based on shared R1 groupings. Increasing time since the original reaction and the presence of a PAL with unknown cephalosporin tolerance predict a lower likelihood of cephalosporin STP.
DOI: 10.1016/j.jaip.2020.07.056
PubMed URL: 32822918
Type: Journal Article
Subjects: Allergy
Immediate hypersensitivity
Skin testing
Appears in Collections:Journal articles

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