Figure 2. Cephalosporin Algorithms Option 1
Cephalosporin administration to a patient with a history of penicillin allergy
nonirritating concentration) –
with cephalosporin (using Consider skin testing +
Give cephalosporin via graded challenge
Options: > Give alternate drug > Desensitize to cephalosporin
Option 2 Option 3 Penicillin skin testing – Give cephalosporin
Options: > Give alternate drug
> Give cephalosporin via graded challenge; fewer than 2% will react in 24 hours, but reactions may be anaphylactic
> Desensitize to cephalosporin
Give cephalosporin directly (only in absence of severe and/or recent penicillin allergy reaction history). Although fewer than 1% will have a reaction within 24 hours, this is controversial since their reactions may be anaphylactic.
Penicillin administration to a patient with a history of cephalosporin allergy
Give penicillin via graded challenge
Penicillin skin testing –
Give penicillin +
+
Give alternate drug or desensitize to penicillin
Cephalosporin administration to a patient with a history of allergy to another cephalosporin
Via graded challenge, give cephalosporin that does not share identical side chain with previous cephalosporin
Administer via graded challenge or possibly via desensitization
Skin test with new cephalosporin using nonirritating concentration (This testing is not standardized)
– Options: +
> Give alternate drug > Desensitize to the cephalosporin
13
