Drug allergy evaluation for betalactam hypersensitivity: Cross-reactivity with cephalosporines, carbapenems and negative predictive value

Asian Pac J Allergy Immunol. 2018 Mar;36(1):27-31. doi: 10.12932/AP0853.


Background: There are no studies on cross-reactivity of betalactams among patients allergic to penicillin, or on the negative predictive value (NPV) of penicillin allergy evaluation from Arabian Gulf countries.

Objective: We aimed to assess the role and NPV of drug provocation test (DPT) for betalactam hypersensitivity reactions in patients referred for allergy evaluation in Kuwait.

Methods: Skin test (ST) was performed for all patients with a history of betalactam hypersensitivity, other than anaphylaxis. Patients with a negative ST were challenged with a DPT containing phenoxymethyl penicillin or the culprit drug. Patients with anaphylaxis or who tested positive to betalactams were then challenged with a DPT containing cefuroxime, meropenem or ceftriaxone. Patients who tested negative were contacted by phone to evaluate subsequent betalactam intake.

Results: A total of 214 patients were tested for betalactam hypersensitivity. We had 91(42.5%) positive cases. Among positives, there were 78 (85.7%) patients with an initial reaction to penicillin and 13 (14.3%) who reacted to cephalosporin. DPT with alternative betalactam was performed in fifty who tested positive for betalactam hypersensitivity and 45 (90%) tolerated alternative antibiotics. Phone calls to 113 (59.8%) patients with negative betalactam testing showed that among 40(35.4%) patients who were successfully contacted; 17 (15%) took betalactams and 23 (20%) did not. Among the 17 patients who took betalactams, our calculated NPV for penicillin testing range from 88.2 to 100%, as the 2 patients who reported a reaction refused confirmatory retesting.

Conclusion: Carbapenems and cephalosporines can be safely given to penicillin allergic patients by means of skin testing and if negative, proceeding with a graded challenge. Our calculated NPV for penicillin testing is similar to other studies.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / adverse effects*
  • Carbapenems / immunology*
  • Cephalosporins / immunology*
  • Child
  • Cross Reactions
  • Drug Hypersensitivity / diagnosis*
  • Drug Hypersensitivity / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Penicillins / adverse effects*
  • Penicillins / immunology
  • Predictive Value of Tests
  • Skin Tests / methods
  • beta-Lactams / adverse effects
  • beta-Lactams / immunology


  • Anti-Bacterial Agents
  • Carbapenems
  • Cephalosporins
  • Penicillins
  • beta-Lactams