TOPLINE:

In children with low-risk allergies to oral cephalosporins, direct challenges showed remarkable safety, with 97.5% of challenges being asymptomatic and no cases requiring epinephrine.

METHODOLOGY:

• Researchers sought to assess the safety and efficacy of direct challenges with oral cephalosporins in children at four institutions in the US.
• All participants (n = 313; median age at the time of challenge, 7.5 years; 50% girls; 77% White) underwent a direct oral challenge with culprit cephalosporins per protocol, including single-dose cefdinir and/or two-step graded cefprozil challenges.
• Researchers excluded high-risk patients who had a history of anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms, fixed drug eruption, or end-organ damage.

TAKEAWAY:

• Overall, 68% of participants had multiple drug allergy labels, with 58% having both penicillin and cephalosporin allergy labels; 26% had an additional non-beta-lactam antibiotic allergy label.
• Of the 314 direct oral challenges performed, 97.5% were asymptomatic, with only eight children developing mild cutaneous reactions, and none required epinephrine.
• About 54 children successfully tolerated subsequent courses of cephalosporins after the challenge without relabeling.

IN PRACTICE:

“We encourage a proactive approach to cephalosporin allergy labels in children given the low rate of confirmation,” the authors of the study wrote.

SOURCE:

Christine R.F. Rukasin, MD, Phoenix Children’s Hospital, Phoenix, was the corresponding author of the study, which was published online on October 16, 2025, in The Journal of Allergy and Clinical Immunology: In Practice.

LIMITATIONS:

The study was limited by incomplete data on reaction, medical, and family histories, and the requirement for patients, caregivers, and healthcare providers to agree to oral challenges may have introduced selection bias toward those with milder symptoms. Additionally, the high rate of asymptomatic challenges observed may have reflected bias inherent in risk stratification strategies and may not have been generalizable across all cephalosporin reaction phenotypes. The number of children tolerating subsequent courses may have been underestimated due to limited follow-up after returning to community care.

DISCLOSURES:

One author reported receiving funding from AHRQ K12 HS026395 and AHRQ R01HS030234 and receiving the AAAAI Foundation Faculty Development Award; she also disclosed receiving unrelated funding support from NIAID U01AI181927 and a pilot award for research from the Vanderbilt-Ingram Cancer Center/Chic Awareness.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.