Validation of the cephalosporin intradermal skin test for predicting immediate hypersensitivity: a prospective study with drug challenge

• Published in: Allergy (Copenhagen) Vol. 68; no. 7; pp. 938 - 944
• Main Authors: Yoon, S.‐Y., Park, S. Y., Kim, S., Lee, T., Lee, Y. S., Kwon, H.‐S., Cho, Y. S., Moon, H.‐B., Kim, T.‐B.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01-07-2013
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; cephalosporin; Cephalosporins - adverse effects; Cephalosporins - pharmacology; Cohort Studies; drug hypersensitivity; Drug Hypersensitivity - epidemiology; Drug Hypersensitivity - etiology; Drug Hypersensitivity - immunology; Drug therapy; Female; Humans; Hypersensitivity, Immediate - chemically induced; Hypersensitivity, Immediate - diagnosis; Hypersensitivity, Immediate - epidemiology; Incidence; intradermal test; Intradermal Tests; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Risk Assessment; Sensitivity analysis; Sensitivity and Specificity; Sex Distribution; Skin; skin test; Young Adult; intradermal test; cephalosporin; drug hypersensitivity; skin test
• ISSN: 0105-4538; 1398-9995
• DOI: 10.1111/all.12182

Background
Cephalosporin is a major offending agent in terms of drug hypersensitivity along with penicillin. Cephalosporin intradermal skin tests (IDTs) have been widely used; however, their validity for predicting immediate hypersensitivity has not been studied. This study aimed to determine the predictive value of cephalosporin intradermal skin testing before administration of the drug.
Methods
We prospectively conducted IDTs with four cephalosporins, one each of selected first‐, second‐, third‐, or fourth‐generation cephalosporins: ceftezol; cefotetan or cefamandole; ceftriaxone or cefotaxime; and flomoxef, respectively, as well as with penicillin G. After the skin test, whatever the result, one of the tested cephalosporins was administered intravenously and the patient was carefully observed.
Results
We recruited 1421 patients who required preoperative cephalosporins. Seventy‐four patients (74/1421, 5.2%) were positive to at least one cephalosporin. However, none of responders had immediate hypersensitivity reactions after a challenge dose of the same or different cephalosporin, which were positive in the skin test. Four patients who suffered generalized urticaria and itching after challenge gave negative skin tests for the corresponding drug. The IDT for cephalosporin had a sensitivity of 0%, a specificity of 97.5%, a negative predictive value of 99.7%, and a positive predictive value (PPV) of 0%, when challenged with the same drugs that were positive in the skin test.
Conclusion
Routine skin testing with a cephalosporin before its administration is not useful for predicting immediate hypersensitivity because of the extremely low sensitivity and PPV of the skin test (CRIS registration no. KCT0000455).