Journal article
Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins
The Journal of Allergy and Clinical Immunology: In Practice, Vol.9(1), pp.435-444.e13
2020
Abstract
Background
Although 1-2% of the general population carries a cephalosporin allergy label (CAL), we lack validated testing strategies and predictors of true allergy.
Objective
To identify cross-reactivity patterns and predictors of skin test positive (STP) in geographically disparate patients with a CAL.
Methods
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, USA) (n=370) between 2014-2018, underwent a standardized skin testing.
Results
Of 328 patients with CAL, 29 (8.8%) tested STP to ≥ 1 cephalosporin(s). There were no cefazolin or ceftriaxone STP, 0/452 (0%), in patients with a PAL only. 16/328 (4.8%) patients with a CAL were ampicillin STP. 11/16 of these patients had an initial allergy label to cephalexin. 20/29 patients cephalosporin STP demonstrated tolerance to a cephalosporin with a different R1 side chain, and 8/14 ampicillin STP patients demonstrated tolerance of > 1 non-amino R1 group cephalosporin. 11/13 patients STP to cefazolin were skin and ingestion challenge negative to all other penicillins and cephalosporins predicted by its distinct R1/ R2 groups. 7/15 ceftriaxone STP patients demonstrated cross-reactivity with R1-similar cephalosporins. Time since original reaction predicted STP testing to both penicillins, aOR (adjusted odds ratio) per year 0.93 (95% CI 0.90, 0.97), and cephalosporins aOR per year 0.71 (95%CI 0.56, 0.90).
Conclusions
Cephalosporin cross-reactivity is based on shared R1 groupings. Increasing time since original reaction, and the presence of a PAL with unknown cephalosporin tolerance predict a lower likelihood of cephalosporin STP.
Details
- Title
- Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins
- Authors/Creators
- C.A. Stone (Author/Creator)J.A. Trubiano (Author/Creator)E.J. Phillips (Author/Creator)
- Publication Details
- The Journal of Allergy and Clinical Immunology: In Practice, Vol.9(1), pp.435-444.e13
- Publisher
- Elsevier
- Identifiers
- 991005540744607891
- Copyright
- © 2020 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
UN Sustainable Development Goals (SDGs)
This output has contributed to the advancement of the following goals:
Source: InCites
Metrics
58 File views/ downloads
53 Record Views
InCites Highlights
These are selected metrics from InCites Benchmarking & Analytics tool, related to this output
- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.265 Dermatology - Skin Allergies
- 1.265.1140 Drug Hypersensitivity
- Web Of Science research areas
- Allergy
- Immunology
- ESI research areas
- Clinical Medicine