title: Validation of the cephalosporin intradermal skin test for predicting immediate hypersensitivity: a prospective study with drug challenge.
abstract: 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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Yoon
authors.forename: S Y
authors.initials: SY
authors.lastname: Park
authors.forename: S
authors.initials: S
authors.lastname: Kim
authors.forename: T
authors.initials: T
authors.lastname: Lee
authors.forename: Y S
authors.initials: YS
authors.lastname: Lee
authors.forename: H-S
authors.initials: HS
authors.lastname: Kwon
authors.forename: Y S
authors.initials: YS
authors.lastname: Cho
authors.forename: H-B
authors.initials: HB
authors.lastname: Moon
authors.forename: T-B
authors.initials: TB
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002511:Cephalosporins / Q000009:adverse effects* / Q000494:pharmacology*; D015331:Cohort Studies; D004342:Drug Hypersensitivity / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D015994:Incidence; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D002511:Cephalosporins
keywords: cephalosporin; drug hypersensitivity; intradermal test; skin test