Assessing Pediatric Cephalosporin Allergic Reactions Through Direct Graded Oral Challenges.

Abstract

Cephalosporins, beta-lactam antibiotics, commonly cause allergic reactions. To assess the clinical characteristics and management of pediatric patients with suspected cephalosporin allergy using direct graded oral challenges (GOCs). Children referred for suspected cephalosporin allergy at four Canadian clinics were recruited over 10 years. Data on demographics, clinical reaction characteristics, and management were collected through a questionnaire. Patients underwent a direct GOC (initially 10% of the treatment dose, then 90% after 20 minutes), and reactions were monitored one-week post-challenge. Families were contacted annually for up to five years to detect subsequent antibiotic reactions. Logistic regression analysis identified factors associated with positive GOC reactions. Among the 136 patients reporting cephalosporin allergy, 75 (55.1%) were males with a median age of 3.9 years (IQR, 2.3 to 8.7). Cefprozil represented the most common cephalosporin linked to the index reaction (67.6% of cases). Of the 136 direct GOCs, 5.1% had an immediate and 4.4% non-immediate reaction, respectively. Positive GOCs conducted in children with a history of skin-limited non-severe rashes were classified as mild, benign skin rashes. Positive GOCs were more likely in children with food allergies [adjusted Odds Ratio (aOR) 1.14 (95% CI 1.00, 1.29)]. Direct GOCs are safe and effective for diagnosing pediatric cases who report non-vesicular skin-limited symptoms while treated with cephalosporins.