Safety of cephalosporin administration in patients with a history of penicillin allergy and a negative penicillin skin test

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RATIONALE: To determine the rate of adverse drug reactions (ADR) to cephalosporins in patients with a history of penicillin (PCN) allergy but a negative PCN skin test. METHODS: 1120 consecutive patients with a history of PCN allergy were evaluated by an allergist for PCN allergy in a pre-operative evaluation clinic from July 2002 to September 2003. Patients were followed and charts reviewed to determine the rate of ADR to cephalosporins perioperatively. RESULTS: Of the 1120 patients, 1031 underwent PCN skin testing, 84 did not, and 5 charts were not available for review. The mean age of the study group was 60 years. 974 of 1031 (94%) patients had a negative PCN skin test. Of these, 687 received cefazolin, 30 cephalexin, 7 cefepime, and 6 ceftriaxone. Five (0.7%) patients had an ADR to the cephalosporins despite a negative PCN skin test. Four were to cefazolin and one to ceftriaxone. Among the patients with ADR to cefazolin, one had hypotension, two pruritus, and one throat swelling and difficulty breathing. ADR to ceftriaxone was reported to be serum sickness-like symptoms. 21 of 84 (25%) who did not undergo PCN skin testing received cefazolin, and 1 of 21 (5%) had ADR (hypotension). All patients recovered without further sequela and no further cephalosporins were given. CONCLUSIONS: This is the largest series of patients with a history of PCN allergy and a negative PCN skin test that have been challenged with cephalosporins. The rate of adverse reaction in this group is low (0.7%).