J Korean Med Sci.  2019 Dec;34(50):e319. 10.3346/jkms.2019.34.e319.

Results of Intradermal Skin Testing with Cefazolin according to a History of Hypersensitivity to Antibiotics

Affiliations
  • 1Department of Allergy and Clinical Immunology, Kangwon National University School of Medicine, Chuncheon, Korea.
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. addchang@snu.ac.kr
  • 3Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
  • 4Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

BACKGROUND
The relationship between cephalosporin hypersensitivity and a history of β-lactam hypersensitivity is unclear. We evaluated the usefulness of routine intradermal cefazolin skin testing and its relationship with the history of β-lactam hypersensitivity.
METHODS
The electronic medical records of patients who underwent intradermal cefazolin (0.3 mg/mL) skin testing without negative controls from January 2010 to January 2011 at Seoul National University Bundang Hospital were evaluated. The history of β-lactam hypersensitivity of the patients was taken. Immediate adverse reactions after cefazolin injection were evaluated by searching the electronic medical records for key words and reviewing consultation documents of allergy specialists or dermatologists. The medical records of the patients were reviewed by an allergist.
RESULTS
There were 13,153 cases of cefazolin skin testing over the 13-month study period. Among the 12,969 cases with negative skin test results, 8 had immediate hypersensitivity related to cefazolin (0.06%). The negative predictive value of cefazolin skin testing alone was 99.94%. The overall positivity rate of cefazolin skin tests was 1.4% (184/13,153). Of the cases with a history of allergy to β-lactams, 15% (6/40) showed a positive cefazolin skin test result compared to only 1.36% (178/13,113) of cases with no such history (P < 0.001) including some false-positive tests.
CONCLUSION
The results suggest that routine screening involving cefazolin skin testing without negative controls is not useful for all patients, but could be helpful for those with a history of β-lactam hypersensitivity, although a large prospective study is needed to confirm this.

Keyword

Intradermal Tests; Skin Tests; Cefazolin; Drug Hypersensitivity

MeSH Terms

Anti-Bacterial Agents*
Cefazolin*
Drug Hypersensitivity
Electronic Health Records
Humans
Hypersensitivity*
Hypersensitivity, Immediate
Intradermal Tests
Mass Screening
Medical Records
Prospective Studies
Seoul
Skin Tests*
Skin*
Specialization
Anti-Bacterial Agents
Cefazolin
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