Predictive value of intradermal test on anaphylaxis induced by ceftriaxone sodium: a retrospective study

Abstract

Objective To explore the predictive value of intradermal test on anaphylaxis induced by ceftriaxone sodium retrospectively. Methods Medical records of patients who underwent intradermal test before ceftriaxone sodium treatment in the First Hospital of Quanzhou Affiliated to Fujian Medical University from November 2013 to June 2015 were collected with random equidistant sampling and analyzed retrospectively. The patients were divided into the positive intradermal test group and the negative intradermal test group according to the results of intradermal test. The situation of medication in patients in the positive intradermal test group and the ages, onset time of anaphylaxis, clinical manifestations, and outcomes in patients with allergic reactions after ceftriaxone sodium treatment in the negative intradermal test group were analyzed, respectively. The difference between the incidence of anaphylactic reactions after ceftriaxone sodium treatment in the negative intradermal test group and the hypothetical incidence of anaphylactic reactions after ceftriaxone sodium treatment without intradermal test were calculated according to Poisson distribution principle. Results A total of 943 patients were enrolled in the study, including 30 patients (3.18%) in the positive intradermal test group and 913 patients (96.82%) in the negative intradermal test group. Neither the positive and negative control tests nor the provocative tests were performed in patients in the positive intradermal test group and no allergic reactions appeared in these patients in the following treatments with cefoperazone sodium and sulbactam sodium, ceftizoxime, azithromycin, levofloxacin, amoxicillin sulbactam, teicoplanin, and moxifloxacin, respectively. Ten (1.1%) of 913 patients in the negative intradermal test group developed anaphylaxis during the use of ceftriaxone sodium, the incidence of anaphylactic reaction was 1.10%, in whom male and female were 5 respectively, aged 10 months to 52 years, 6 patients were 10 years old. Of the 10 patients with anaphylactic reactions, 4 developed within 20 minutes and 6 developed 4 to 10 days, respectively after the administration. The main symptoms were rash and pruritus, which improved after drug withdrawal and symptomatic treatments. There were no significant difference (u=0.288, P=0.77) between the incidence of anaphylactic reactions in the negative intradermal test group (1.1%) and the hypothetical incidence of ceftriaxone sodium-induced anaphylactic reactions without intradermal test (1.0%). Conclusion The incidence of anaphylaxis did not decrease significantly in patients with negative intradermal test, suggesting that the intradermal test has no obvious value to predict the occurrence of ceftriaxone sodium-induced anaphylaxis. Key words: Cephalosporins; Intradermal tests; Anaphylaxis; Forecasting