Logo image
Back
Evaluation of cephalosporin allergy: Survey of drug allergy experts
Journal article   Open access   Peer reviewed

Evaluation of cephalosporin allergy: Survey of drug allergy experts

Anna Brameli, Cosby A. Stone and Elizabeth J. Phillips
The journal of allergy and clinical immunology. Global, Vol.4(1), 100351
2025
DOI: https://doi.org/10.1016/j.jacig.2024.100351
PMID: 39624180
pdf
cephalosporin1,019.60 kBDownloadView
Open Access CC BY-NC-ND V4.0

Abstract

Adverse Reactions to Drugs, Biologics, and Latex Committee (ARDBL) of the AAAAI cephalosporin Drug allergy drug allergy practice parameter
Since the publication of the 2022 Drug Allergy Practice Parameters (DAPP) of the American Academy of Allergy, Asthma & Immunology (AAAAI) and American College of Allergy, Asthma & Immunology (ACAAI), it is unclear the extent to which the simplified and risk-stratified evaluation of cephalosporin allergy has been incorporated into allergy practice. We aimed to assess current cephalosporin allergy testing practices using real case examples. An 18-question REDCap survey was sent to the 136 members of the Adverse Reactions to Drugs, Biologics and Latex (ARDBL) Committee of the AAAAI between February and April 2023. Forty-six (33.8%) ARDBL members completed the survey after 3 email attempts. Most practiced in the United States (32, 69.6%), 6 (13.0%) in Canada, and the rest in Europe and Asia. Almost half (47.7%) reported that the 2022 DAPP had increased their use of direct oral challenge, and 91% would prescribe cephalosporins in the setting of low-risk penicillin allergy history without testing. For low-risk cephalosporin reactions, 68% would perform a direct oral challenge with the culprit drug. In severe immediate penicillin reactions, 23% would evaluate with penicillin skin test before assessing cephalosporin allergy. For cephalosporin-related anaphylaxis, 48% would perform cephalosporin-based tests. For perioperative anaphylaxis with cefazolin, 57% would perform cephalosporin-based tests. For positive skin test result to cefazolin, 79% chose to avoid the culprit drug with follow-up oral challenge to a structurally dissimilar cephalosporin. Increased uptake of direct oral challenge represents the initial impact of the 2022 DAPP. However, there is significant variation in testing practices of cephalosporin allergy even among drug allergy experts, reflecting a need for a firmer evidence base to guide consensus around testing for higher-risk reactions.

Details

UN Sustainable Development Goals (SDGs)

This output has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

Source: SDGs in the Output

Metrics

1 Record Views
2 Times Cited - Web of Science
Logo image