Cephalosporin Allergy: Current Understanding and Future Challenges

David A. Khan, Aleena Banerji, Jonathan A. Bernstein, Basar Bilgicer, Kimberly Blumenthal, Mariana Castells, Daniel Ein, David M. Lang, Elizabeth Phillips

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


Cephalosporins are commonly used antibiotics both in hospitalized patients and in outpatients. Hypersensitivity reactions to cephalosporins are becoming increasingly common with a wide range of immunopathologic mechanisms. Cephalosporins are one of the leading causes for perioperative anaphylaxis and severe cutaneous adverse reactions. Patients allergic to cephalosporins tend to tolerate cephalosporins with disparate R1 side chains but may react to other beta-lactams with common R1 side chains. Skin testing for cephalosporins has not been well validated but appears to have a good negative predictive value for cephalosporins with disparate R1 side chains. In vitro tests including basophil activation tests have lower sensitivity when compared with skin testing. Rapid drug desensitization procedures are safe and effective and have been used successfully for immediate and some nonimmediate cephalosporin reactions. Many gaps in knowledge still exist regarding cephalosporin hypersensitivity.

Original languageEnglish (US)
Pages (from-to)2105-2114
Number of pages10
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number7
StatePublished - Sep 1 2019


  • Allergy
  • Anaphylaxis
  • Beta-lactam
  • Cephalosporin
  • Cross-reactivity
  • Penicillin
  • Skin test

ASJC Scopus subject areas

  • Immunology and Allergy


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