Assessing Pediatric Cephalosporin Allergic Reactions Through Direct Graded Oral Challenges

Area of Science:

• Allergy and Immunology
• Pediatric Pharmacology
• Clinical Diagnostics

Background:

• Cephalosporins, a common class of β-lactam antibiotics, are frequently associated with allergic reactions.
• Accurate diagnosis of antibiotic allergy is crucial for appropriate patient management and preventing broad-spectrum antibiotic use.

Purpose of the Study:

• To evaluate the safety and efficacy of direct graded oral challenges (GOCs) in diagnosing suspected cephalosporin allergy in pediatric patients.
• To characterize the clinical presentation and outcomes of children undergoing GOCs for cephalosporin allergy.

Main Methods:

• A prospective study involving 136 pediatric patients referred for suspected cephalosporin allergy across four Canadian clinics over ten years.
• Patients underwent direct graded oral challenges (GOCs) with cephalosporins, with reactions monitored immediately and up to one week post-challenge.
• Logistic regression analysis was used to identify factors associated with positive GOC reactions, including a history of food allergies.

Main Results:

• Of 136 patients, 55.1% were male with a median age of 3.9 years. Cefprozil was the most common implicated cephalosporin (67.6%).
• Direct GOCs resulted in immediate reactions in 5.1% and non-immediate reactions in 4.4% of patients. Positive reactions were typically mild, skin-limited rashes.
• Children with a history of food allergies were more likely to have a positive GOC (adjusted odds ratio 1.14).

Conclusions:

• Direct graded oral challenges (GOCs) are a safe and effective diagnostic tool for pediatric patients reporting nonvesicular, skin-limited symptoms attributed to cephalosporins.
• GOCs facilitate accurate diagnosis, enabling de-labeling of penicillin allergy and guiding appropriate antibiotic selection in children.