Cephalosporin hypersensitivity: descriptive analysis, cross-reactivity and risk factors.

Touati, Nidhal; Cardoso, Barbara; Delpuech, Marie; Bazire, Raphaelle; El Kara, Nathalie; Ouali, Djamila; Demoly, Pascal; Anca-Mirela, C H I R I A C

BACKGROUND Cephalosporins, which belong to the beta lactams therapeutic class, are increasingly used throughout the world. Few large studies on this issue have been conducted and most of them have been performed as part of penicillin hypersensitivity studies. OBJECTIVE We described our 26-year experience exploring cephalosporin drug hypersensitivity, from which we identified epidemiological and cross-reactivity data. METHODS We included 476 patients who reported Drug Hypersensitivity Reaction (DHR) to cephalosporin and underwent an allergy workup between January 1992 and July 2018 in the Allergy Unit of the University Hospital of Montpellier (France). According to their structural side chain R1 homology we worked with four classes of cephalosporins. Logistic regression analysis was used to search for risk factors for hypersensitivity to cephalosporin (positive skin test or provocation test results). RESULTS Cephalosporin hypersensitivity was proven in 22.3% of the patients referred in our Unit, according to positive ST (51.9%) or DPT to the culprit drug (48.1%). One in five patients were children and cephalosporin hypersensitivity was confirmed in 15% (47.6% of them by means of ST). In the cephalosporin hypersensitive population, initial reactions were mostly immediate (68.9%) and anaphylactic (72.7%). Cross-reactivity with aminopenicillins was the most frequent pattern of cross-reactivity. In multivariate analysis, immediate reactions (OR=3 (95%CI [1.6-5.5]), p<0.001)), anaphylactic shock (OR=6.5 (95%CI [3.3-13.1], p<0.001)) and anaphylaxis (OR=3.1 (95%CI [1.6-6.1], p<0.001)) and multiple reactions to the same or several cephalosporins (OR=2.0 (95% CI [1-3.5], p=0.04)) were statistically associated with confirmed DHR. DPT was generally safe, but elicited anaphylaxis in 20% of patients. Systemic reactions during skin testing occurred in 9.1% of positive patients, almost always related to anaphylactic index reactions. Non-immediate confirmed DHR to cephalosporins were rare and occurred in less than 10% of the positive patients. CONCLUSION Almost a quarter of the tested patients were confirmed as hypersensitive to cephalosporins; sensitivity of skin testing was 51.9%, thus, half of the positive patients needed a DPT in order to prove the diagnosis.