Clinical options for managing patients with penicillin allergy who have a compelling need for cephalosporins

American Family Physician,  May 1, 2005  

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Desensitize without cephalosporin testing. This option is supported by practice measures, but requires admission to the intensive care unit, delays reaching "full strength" antibiotic dose, and does not clarify whether patient is allergic to cephalosporins.

Graded cephalosporin challenge without skin testing. This option is safer than starting with a full dose, and a full dose can be reached within two hours. However, there is a medicolegal risk of reaction without desensitization effort, reaching "full strength" is delayed, and the question of cephalosporin allergy is not clarified.

Skin test with cefuroxime or ceftriaxone. * If negative, give a graded challenge of the tested cephalosporin. This option appears to be safe based on this study, avoids the need for admission to the intensive care unit, results in a shorter delay (i.e., two hours) to reaching full antibiotic strength, and clarifies the question of cephalosporin allergy. However, medicolegal issues remain if desensitization is not performed.

*--Recommended by the authors.

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