Assessing Pediatric Cephalosporin Allergic Reactions Through Direct Graded Oral Challenges

Carly Sillcox, Sofianne Gabrielli, Andrew O'Keefe, Christine McCusker, Elissa M Abrams, Thomas Eiwegger, Adelle Atkinson, Vy Kim, Ana-Maria Copaescu, Moshe Ben-Shoshan

Research output: Journal article (peer-reviewed)Journal article

2 Citations (Scopus)


BACKGROUND: Cephalosporins, β-lactam antibiotics, commonly cause allergic reactions.

OBJECTIVE: To assess the clinical characteristics and management of pediatric patients with suspected cephalosporin allergy using direct graded oral challenges (GOCs).

METHODS: Children referred for suspected cephalosporin allergy at 4 Canadian clinics were recruited over 10 years. Data on demographics, clinical reaction characteristics, and management were collected through a questionnaire. Patients underwent a direct GOC (initially 10% of the treatment dose, then 90% after 20 min), and reactions were monitored 1 week postchallenge. Families were contacted annually for up to 5 years to detect subsequent antibiotic reactions. Logistic regression analysis identified factors associated with positive GOC reactions.

RESULTS: Among the 136 patients reporting cephalosporin allergy, 75 (55.1%) were males with a median age of 3.9 years (interquartile range 2.3-8.7). Cefprozil represented the most common cephalosporin linked to the index reaction (67.6% of cases). Of the 136 direct GOCs, 5.1% had an immediate and 4.4% a nonimmediate reaction, respectively. Positive GOCs conducted in children with a history of skin-limited nonsevere rashes were classified as mild, benign skin rashes. Positive GOCs were more likely in children with food allergies (adjusted odds ratio 1.14; 95% confidence interval [95% CI] 1.00-1.29).

CONCLUSIONS: Direct GOCs are safe and effective for diagnosing pediatric cases that report nonvesicular skin-limited symptoms while being treated with cephalosporins.

Original languageEnglish
Pages (from-to)156-164.e4
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number1
Early online date11 Oct 2023
Publication statusPublished - Jan 2024


  • Anti-Bacterial Agents/adverse effects
  • Canada/epidemiology
  • Cephalosporins/adverse effects
  • Child
  • Child, Preschool
  • Drug Hypersensitivity/diagnosis
  • Female
  • Humans
  • Hypersensitivity/complications
  • Male
  • Monobactams
  • Penicillins/adverse effects
  • Skin Tests/adverse effects


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