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Results of Intradermal Skin Testing with Cefazolin according to a History of Hypersensitivity to Antibiotics

Journal of Korean Medical Science 2019년 34권 50호 p.319 ~ 319
권재우 ( Kwon Jae-Woo ) - Kangwon National University School of Medicine Department of Allergy and Clinical Immunology

김윤정 ( Kim Yoon-Jeong ) - Seoul National University College of Medicine Department of Internal Medicine
양민석 ( Yang Min-Suk ) - Seoul National University College of Medicine Department of Internal Medicine
송우정 ( Song Woo-Jung ) - University of Ulsan College of Medicine Asan Medical Center Department of Allergy and Clinical Immunology
김세훈 ( Kim Sae-Hoon ) - Seoul National University College of Medicine Department of Internal Medicine
조상헌 ( Cho Sang-Heon ) - Seoul National University College of Medicine Department of Internal Medicine
장윤석 ( Chang Yoon-Seok ) - Seoul National University College of Medicine Department of Internal Medicine

Abstract


Background: The relationship between cephalosporin hypersensitivity and a history of β-lactam hypersensitivity is unclear. We evaluated the usefulness of routine intradermal cefazolin skin testing and its relationship with the history of β-lactam hypersensitivity.

Methods: The electronic medical records of patients who underwent intradermal cefazolin (0.3 mg/mL) skin testing without negative controls from January 2010 to January 2011 at Seoul National University Bundang Hospital were evaluated. The history of β-lactam hypersensitivity of the patients was taken. Immediate adverse reactions after cefazolin injection were evaluated by searching the electronic medical records for key words and reviewing consultation documents of allergy specialists or dermatologists. The medical records of the patients were reviewed by an allergist.

Results: There were 13,153 cases of cefazolin skin testing over the 13-month study period. Among the 12,969 cases with negative skin test results, 8 had immediate hypersensitivity related to cefazolin (0.06%). The negative predictive value of cefazolin skin testing alone was 99.94%. The overall positivity rate of cefazolin skin tests was 1.4% (184/13,153). Of the cases with a history of allergy to β-lactams, 15% (6/40) showed a positive cefazolin skin test result compared to only 1.36% (178/13,113) of cases with no such history (P < 0.001) including some false-positive tests.

Conclusion: The results suggest that routine screening involving cefazolin skin testing without negative controls is not useful for all patients, but could be helpful for those with a history of β-lactam hypersensitivity, although a large prospective study is needed to confirm this.

키워드

Intradermal Tests; Skin Tests; Cefazolin; Drug Hypersensitivity
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