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Diagnosing hypersensitivity reactions to cephalosporins in children

Antonino Romano1, Francesco Gaeta, Rocco Luigi Valluzzi

  • 1Unità di Allergologia, Complesso Integrato Columbus, Via G. Moscati, 31, 00168 Rome, Italy. antoninoromano@h-columbus.it.

Pediatrics
|September 3, 2008
PubMed

Insights

Most nonimmediate hypersensitivity reactions to cephalosporins are not true allergies. However, immediate reactions are often IgE-mediated, and cephalosporin skin testing is valuable for diagnosis.

Area of Science:

  • Allergy and Immunology
  • Pediatric Allergy
  • Pharmacovigilance

Background:

  • Hypersensitivity reactions to cephalosporins can present with immediate or nonimmediate manifestations.
  • Accurate diagnosis is crucial for patient management and to avoid unnecessary drug avoidance.

Purpose of the Study:

  • To assess the diagnostic utility of skin tests, patch tests, specific IgE assays, and challenges for cephalosporin hypersensitivity.
  • To elucidate the pathogenic mechanisms underlying these reactions.

Main Methods:

  • Evaluated 148 children with suspected cephalosporin hypersensitivity.
  • Employed immediate and delayed skin tests, patch tests, serum specific IgE, and drug challenges based on reaction timing.
  • Reevaluations and therapeutic challenges were performed in select cases.

Main Results:

  • Only 1 of 105 children with nonimmediate reactions showed positive skin or patch tests.
  • Among 43 children with immediate reactions, 33 had positive skin tests; 79% were diagnosed with IgE-mediated hypersensitivity.
  • Most children tolerated drug challenges, indicating a low incidence of true hypersensitivity for nonimmediate reactions.

Conclusions:

  • Nonimmediate cephalosporin reactions are rarely true hypersensitivity.
  • Immediate cephalosporin reactions are frequently IgE-mediated.
  • Cephalosporin skin testing is a useful diagnostic method for immediate hypersensitivity reactions.
Abstract

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