Clinical outcome in the use of cephalosporins in pediatric patients with a history of penicillin allergy

Background: The risk of cephalosporin administration in patients with a history of penicillin allergy is unclear. Few studies have looked at the risk of cephalosporin administration in children following penicillin skin testing for suspected penicillin allergy. The goal of this study was to determine whether children with penicillin allergy were at increased risk for adverse drug reactions when administered a cephalosporin. Methods: A retrospective chart review was conducted in pediatric patients (≤18 years) with a history of penicillin allergy and a positive or negative penicillin skin test who were administered a cephalosporin after testing. Charts were reviewed for adverse drug reactions to the cephalosporin. Results: A total of 173 patients (91 males) were included in this study. The mean age of the patients was 4.1 ± 3.1 years. Twenty-one patients (12%) tested positive in a penicillin skin test and 152 patients (88%) tested negative. One patient with a negative penicillin skin test (0.7%) had an adverse drug reaction (eye swelling) to cephalexin. None of the patients with a positive penicillin skin test who received a course of cephalosporin had an adverse drug reaction. Conclusion: Among all patients with a history of penicillin allergy (penicillin skin test positive and negative), only 1 person had an adverse drug reaction. Further large prospective studies examining the safety of administering cephalosporins in pediatric patients with confirmed penicillin allergy are needed.