Evaluation of direct oral provocation test results in mild cutaneous reactions to cephalosporins in children.

Abstract

Background: Cephalosporins are beta-lactam antibiotics commonly used in children and are the second most common cause of drug hypersensitivity reactions after penicillins. Antibiotic allergy is diagnosed by tests such as prick and intradermal skin tests and the drug provocation test (DPT). Skin tests can be challenging for both patients and clinicians. In appropriate cases, omitting these tests in favour of direct DPT may help to avoid diagnostic delays. Objective: Our study aimed to evaluate the results of direct DPT in children with a history of mild cutaneous reactions to cephalosporins. Methods: Between 2019 and 2024, pediatric patients with a documented history of mild cutaneous reactions to cephalosporins who underwent direct DPT without prior prick or intradermal skin testing were included in this study conducted at our clinic. Patients with systemic manifestations beyond cutaneous reactions at the time of the index reaction were excluded from the study. Results: The study included 128 patients who underwent direct DPT with cephalosporins. The most commonly suspected drugs were cefixime (45.3%), cefdinir (25.8%) and cefuroxime (18%). While 96.1% did not react, cephalosporin allergy was confirmed in 3.9% but all reactions were limited to skin involvement and none more severe than the index reaction. Conclusion: In our study, direct DPT ruled out suspected allergy in 96.1% of patients with a history of mild skin reactions to cephalosporins. In conclusion, direct oral DPT was found to be a safe and feasible approach for patients with isolated mild skin reactions, effectively bypassing the need for skin testing.