Clinical Outcome in the Use of Cephalosporins in Pediatric Patients with a History of Penicillin Allergy

Abstract

Background: The risk of cephalosporin administration in patients with a history of penicillin allergy is unclear. Few studies have looked at the risk of cephalosporin administration in children following penicillin skin testing for suspected penicillin allergy. The goal of this study was to determine whether children with penicillin allergy were at increased risk for adverse drug reactions when administered a cephalosporin. Methods: A retrospective chart review was conducted in pediatric patients (≤18 years) with a history of penicillin allergy and a positive or negative penicillin skin test who were administered a cephalosporin after testing. Charts were reviewed for adverse drug reactions to the cephalosporin. Results: A total of 173 patients (91 males) were included in this study. The mean age of the patients was 4.1 ± 3.1 years. Twenty-one patients (12%) tested positive in a penicillin skin test and 152 patients (88%) tested negative. One patient with a negative penicillin skin test (0.7%) had an adverse drug reaction (eye swelling) to cephalexin. None of the patients with a positive penicillin skin test who received a course of cephalosporin had an adverse drug reaction. Conclusion: Among all patients with a history of penicillin allergy (penicillin skin test positive and negative), only 1 person had an adverse drug reaction. Further large prospective studies examining the safety of administering cephalosporins in pediatric patients with confirmed penicillin allergy are needed.

Beta-Lactam Hypersensitivity and Cross-Reactivity

“…More recent studies have shown that the rate of cross-reactivity between penicillins and cephalosporins is much lower than concluded in earlier studies. 35,40,67 –71 One of these studies was prospective in nature, which confirmed penicillin allergy by skin test and 41 patients were treated with cefazolin, cefuroxime, or ceftriaxone and no patients had an allergic reaction. This study concluded that cross-reactivity is low, provided that the side chain is different than that of the penicillin responsible for the allergic reaction.…”

Use of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited

“…However, one (0.7%) of the 152 patients with negative skin test had an immediate allergic reaction after cephalexin, underscoring the lack of predictive power of the penicillin skin test. 50 In a meta-analysis by Pichichero 15 There was a trend towards increased risk for firstgeneration cephalosporins, although the result did not reach statistical significance.…”

“…None developed crossreactivity. 49 Ahmed et al 50 reviewed 173 children with a history of penicillin hypersensitivity, with or without a skin test, who underwent cephalosporin challenge. None among those with positive skin test showed reactivity.…”

“…However, a positive penicillin skin test does not predict cross-reactivity with cephalosporin. 30,50 Clinicians may perform skin tests using a cephalosporin with a different side-chain to guide clinical use. 10 Unfortunately, the diagnostic accuracy of cephalosporin skin test is difficult to establish.…”

Is a Reported Penicillin Allergy Sufficient Grounds to Forgo the Multidimensional Antimicrobial Benefits of β-Lactam Antibiotics?

“…Unfortunately, these false data have populated medical practice, resulting in the propagation of the 10% cross-allergy myth across decades. In contrast, more careful recent studies demonstrate clinically significant immunologically mediated cross-reactivity of <1% [63][64][65][66][67]. These low rates have been incorporated into guidelines within the anaphylaxis practice parameter.…”