ArticleThe journal of allergy and clinical immunology. In practice2021
Testing Strategies and Predictors for Evaluating Immediate and Delayed Reactions to Cephalosporins.
Article in The journal of allergy and clinical immunology. In practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 47 citations in OpenAlex.
- Effects of Sex and Gender in Immediate β-Lactam Antibiotic Allergy: A Systematic Review and Meta-Analysis.The journal of allergy and clinical immunology. In practice · 2025Pooled it
- The Pragmatic Removal of Penicillin Allergy Electronic Health Record Labels (PROPEL) Trial: A Randomized Clinical Trial.The journal of allergy and clinical immunology. In practice · 2025Trial
- Guideline-concordant cefazolin prophylaxis in penicillin allergy labeled arthroplasty patients: Progress and persistent barriers.Journal of clinical orthopaedics and trauma · 2026Article
- Delabeling penicillin allergies in plastic and reconstructive surgery: Cefazolin as the cornerstone for antibiotic prophylaxis.JPRAS open · 2026Review
- Cephalosporin allergy: R1 side-chain and penicillin cross-reactivity patterns in an Australian cohort.The journal of allergy and clinical immunology. Global · 2026Article
- Anaphylaxis to Penicillin: Harvesting Insights From the Food and Drug Administration's Adverse Event Reporting System.The journal of allergy and clinical immunology. In practice · 2025Article
- Direct oral challenges safely reduce the burden of low-risk cephalosporin allergy labels.The journal of allergy and clinical immunology. In practice · 2025Article
- Evaluation of cephalosporin allergy: Survey of drug allergy experts.The journal of allergy and clinical immunology. Global · 2025Article
- Is the Anamnesis Enough to De-Label Patients with Reported Beta-Lactam Allergy?Journal of clinical medicine · 2024Article
- A call to address penicillin allergy labels in patients with hematopoietic stem cell transplants: How to avoid rash decisions.Transplant infectious disease : an official journal of the Transplantation Society · 2024Review
- Cephalosporin Allergy: Updates on Diagnostic Testing.Current allergy and asthma reports · 2024Review
- Impacts of risk-stratified inpatient penicillin allergy label delabeling on subsequent antimicrobial spectrum index and costs.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs.JAC-antimicrobial resistance · 2022Review
- Retrospective stratification of cephalosporin allergy label risk using validated penicillin allergy frameworks.The journal of allergy and clinical immunology. In practice · 2022Article
- Changes in Sensitization Patterns in the Last 25 Years in 619 Patients with Confirmed Diagnoses of Immediate Hypersensitivity Reactions to Beta-Lactams.Biomedicines · 2022Article
- Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement.The World Allergy Organization journal · 2022Review
- Immediate and Delayed Hypersensitivity Reactions to Beta-Lactam Antibiotics.Clinical reviews in allergy & immunology · 2022Review
- Low-risk penicillin allergy delabeling through a direct oral challenge in immunocompromised and/or multiple drug allergy labeled patients in a critical care setting.The journal of allergy and clinical immunology. In practice · 2022Article
- Understanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting.The Journal of the American Academy of Orthopaedic Surgeons · 2022Review
- Hidden Dangers: Recognizing Excipients as Potential Causes of Drug and Vaccine Hypersensitivity Reactions.The journal of allergy and clinical immunology. In practice · 2021Review
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundAlthough 1% to 2% of the general population carries a cephalosporin allergy label (CAL), we lack validated testing strategies and predictors of true allergy.
objectiveTo identify cross-reactivity patterns and predictors of skin test positive (STP) in geographically disparate patients with a CAL.
methodsA total of 780 adult patients labeled with a CAL or penicillin allergy label (PAL) with unknown tolerance of cephalosporins identified from the Austin Hospital (Melbourne, Australia) (n = 410) and Vanderbilt University Medical Center (Nashville, TN) (n = 370) between 2014 and 2018 underwent a standardized skin testing.
resultsOf 328 patients with a CAL, 29 (8.8%) tested STP to ≥1 cephalosporin(s). There were no cefazolin or ceftriaxone STP, 0 of 452 (0%), in patients with a PAL only. Of 328 patients with a CAL, 16 (4.8%) were ampicillin STP. Eleven of 16 of these patients had an initial allergy label to cephalexin. Twenty of 29 cephalosporin STP patients demonstrated tolerance to a cephalosporin with a different R1 side chain, and 8 of 14 ampicillin STP patients demonstrated tolerance to ≥1 non-amino R1 group cephalosporin. Eleven of 13 patients STP to cefazolin were skin and ingestion challenge negative to all other penicillins and cephalosporins predicted by its distinct R1/R2 groups. Seven of 15 ceftriaxone STP patients demonstrated cross-reactivity with R1-similar cephalosporins. Time since the original reaction predicted STP testing to both penicillins, adjusted odds ratio (aOR) per year 0.93 (95% confidence interval [CI]: 0.90, 0.97), and cephalosporins, aOR per year 0.71 (95% CI: 0.56, 0.90).
conclusionsCephalosporin cross-reactivity is based on shared R1 groupings. Increasing time since the original reaction and the presence of a PAL with unknown cephalosporin tolerance predict a lower likelihood of cephalosporin STP.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.