ArticleThe journal of allergy and clinical immunology. Global2026
Cephalosporin allergy: R1 side-chain and penicillin cross-reactivity patterns in an Australian cohort.
Article in The journal of allergy and clinical immunology. Global, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Cefazolin Versus Antistaphylococcal Penicillins in Methicillin-SusceptibleAntibiotics (Basel, Switzerland) · 2026Review
- Case report: Delayed onset rash, delirium, and cross allergic reactions caused by sequential administration of cefoperazone sulbactam, meropenem, and piperacillin tazobactam.Naunyn-Schmiedeberg's archives of pharmacology · 2026Article
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6 authors.
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Abstract
Background: Cross-reactivity between cephalosporins, and penicillins, is mainly explained by R1 side-chain similarity. However, data on cross-reactivity patterns in cephalosporin-allergic patients, with and without preexisting penicillin allergy labels, are lacking. Objective: We sought to determine whether R1 side-chain groups account for cross-reactivity between cephalosporins, and penicillins with similar R groups, in a cohort of patients with cephalosporin allergy labels, with and without a penicillin allergy history. Methods: A retrospective audit (February 2016 to November 2021) of adult outpatients with cephalosporin allergy labels, who underwent skin prick / intradermal testing and/or oral provocation challenges, was performed at 2 Australian tertiary hospitals. Results: We identified 212 patients with a single cephalosporin allergy label; 97 had coexisting penicillin allergy labels. Fifty-eight (27.4%) patients were confirmed as allergic to the index cephalosporin (47 to cefazolin). The cephalosporin skin testing and oral provocation challenge results were adequately explained by R1 side-chain patterns. Most (87.5%) of the cephalosporin-allergic patients with penicillin allergy labels tolerated a penicillin challenge and were delabelled. However, positive penicillin skin test results were found in 5 (10.2%) cefazolin-allergic patients without preexisting penicillin allergy labels. Conclusions: R1 side-chain groups explained most test outcomes in this study. However, some positive penicillin skin testing results were identified without a history of penicillin allergy. Future research investigating the safety of supervised graded penicillin challenges in cephalosporin-allergic patients is needed.
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