Cephalosporin Hypersensitivity: Descriptive Analysis, Cross-Reactivity, and Risk Factors

Background Cephalosporins, which belong to the beta-lactam therapeutic class, are increasingly used throughout world. Few large studies on this issue have been conducted, and most of them performed as part penicillin hypersensitivity studies. Objective We described our 26-year experience exploring cephalosporin drug hypersensitivity, from we identified epidemiological cross-reactivity data. Methods included 476 patients who reported reaction (DHR) underwent an allergy workup between January 1992 July 2018 in Allergy Unit University Hospital Montpellier (France). According their structural side chain R1 homology, worked with 4 classes cephalosporins. Logistic regression analysis was search for risk factors (positive skin test [ST] or provocation [DPT] results). Results Cephalosporin proven 22.3% referred Unit, according positive ST (51.9%) DPT culprit (48.1%). One 5 were children, confirmed 15% (47.6% by means ST). In hypersensitive population, initial reactions mostly immediate (68.9%) anaphylactic (72.7%). Cross-reactivity aminopenicillins frequent pattern cross-reactivity. multivariate analysis, (odds ratio [OR] = 3, 95% confidence interval [CI] [1.6-5.5], P < .001), shock (OR 6.5, CI [3.3-13.1], .001) anaphylaxis 3.1, [1.6-6.1], multiple same several cephalosporins 2.0, [1-3.5], .04) statistically associated DHR. generally safe, but elicited 20% patients. Systemic during testing occurred 9.1% patients, almost always related index reactions. Nonimmediate DHR rare less than 10% Conclusion Almost a quarter tested cephalosporins; sensitivity 51.9%, thus, half needed prove diagnosis.