Basophil activation test in the assessment of cephalosporin allergy: a case report

Third-generation cephalosporins, including cefotaxime and cefixime, are among the most frequently prescribed antibiotics for the management of a broad range of infections. Although generally considered safe, hypersensitivity reactions may occasionally occur.

A 33-year-old woman was admitted to the plastic surgery department for the management of an open hand fracture following a road traffic accident. On admission, she underwent emergency surgery. After the administration of cefotaxime, she developed a generalized rash associated with pruritus. The antibiotic was discontinued and replaced with cefixime. The patient developed the same allergic reaction shortly after its administration.

The treatment was stopped, and the patient's symptoms resolved completely in a few days. Causality assessment was further supported by a basophil activation test, which showed a positive result, confirming an immunoglobulin E-mediated (type I) hypersensitivity reaction to cephalosporins.

Although the basophil activation test provided supportive evidence in this case, its results should be interpreted with caution due to interlaboratory variability and inherent limitations. The basophil activation test can serve as a complementary tool alongside clinical assessment and other diagnostic methods in suspected drug hypersensitivity.