Related Experiment Video
Updated: Oct 16, 2025
Candidate Gene Testing in Clinical Cohort Studies with Multiplexed Genotyping and Mass Spectrometry
Published on: June 21, 2018
Risk Stratification as a Predictive Factor for Cephalosporin Allergy: A Case-Controlled Study
Ayse Suleyman1, Sadık Toprak2, Nermin Guler1
1Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology., Istanbul, Turkey.
Insights
High-risk and immediate reactions are key predictors of confirmed cephalosporin hypersensitivity in children. This risk stratification model aids in diagnosing pediatric cephalosporin allergy, optimizing testing strategies.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Microbiology
- Drug Hypersensitivity
Background:
- Cephalosporin allergies are less common but less standardized to diagnose in children compared to penicillin allergies.
- A European Academy of Allergy and Clinical Immunology position paper proposed a risk stratification system for suspected beta-lactam hypersensitivity reactions.
Purpose of the Study:
- To evaluate the effectiveness of risk stratification in predicting confirmed cephalosporin hypersensitivity.
- To identify predictive factors for confirmed cephalosporin hypersensitivity in pediatric patients.
Main Methods:
- A case-controlled study involving patients with confirmed cephalosporin hypersensitivity (skin tests and drug provocation).
- Age- and gender-matched control subjects were included.
- Retrospective analysis of patient records with risk stratification based on reaction severity (high/low risk) and timing (immediate/delayed).
Main Results:
- Immediate and high-risk reactions were significantly associated with confirmed cephalosporin hypersensitivity (Odds Ratio [OR] > 5, p < 0.001).
- Multivariate analysis confirmed immediate (OR: 7.5) and high-risk (OR: 5.2) reactions as significant predictors.
- Risk stratification showed distinct distributions between patient and control groups for immediate/delayed and high/low-risk reactions.
Conclusions:
- The developed risk stratification model is applicable to children with suspected cephalosporin allergy.
- Skin testing is valuable for high-risk, immediate reaction patients, potentially reducing drug provocation testing.
- Provocation tests may directly diagnose low-risk patients, while high-risk and immediate reactions predict confirmed allergy.
Background:
Compared to penicillin, cephalosporin allergies are less common in children, and their diagnostic approach is less standardized. A recent European Academy of Allergy and Clinical Immunology position paper provided a risk stratification system for patients with suspected β-lactam hypersensitivity reactions.
Objective:
This study aimed to evaluate risk stratification and predicting factors for confirmed cephalosporin hypersensitivity.
Methods:
The case-controlled study included patients with confirmed cephalosporin hypersensitivity (skin tests, n = 53; drug provocation, n = 19). For each patient, 2 age- and gender-matched control subjects were included in the study. Data were retrieved from patients' records and analyzed retrospectively. Risk stratification was performed according to the severity of index reactions, which was initially divided as high and low risk and then further divided as immediate and nonimmediate.
Results:
According to risk stratification, the patient and control groups were divided as follows: high-risk immediate (66.7% vs. 13%, respectively), high-risk delayed (1.4% vs. 8.3%, respectively), low-risk immediate (16.7% vs. 16%, respectively), and low-risk delayed (15.3% vs. 62.9%, respectively). Immediate reactions (odds ratio [OR]: 12.1, 95% confidence interval [CI]: 9-24.8, p < 0.001) and high-risk reactions (OR: 7.8, 95% CI: 4.1-14.6, p < 0.001) were associated with confirmed cephalosporin hypersensitivity in univariate analysis. Multivariate regression analysis indicated that immediate reactions (OR: 7.5, 95% CI: 3.3-16.8, p < 0.001) and high-risk reactions (OR: 5.2, 95% CI: 2.1-12.9, p < 0.001) were significant risk factors for the prediction of cephalosporin hypersensitivity.
Conclusion:
This model can be applied in children with suspected cephalosporin allergy. Skin testing provides diagnostic information in high-risk patients with immediate reactions and reduces the need for drug provocation testing in these patients. It is highly likely to confirm the diagnosis of low-risk patients directly with provocation tests without skin tests. High-risk and immediate reactions were found to be predictive factors for confirmed cephalosporin allergy.
More Related Videos
Related Concept Videos
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:25Strategies for Assessing and Addressing Confounding
Confounding can be addressed at both the design phase of a study and through analytical methods after data...