Breaking the barrier: Transforming the diagnosis and management of penicillin and cephalosporin allergy in China
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: β-lactam allergy labels are common in routine care but are variably verified. This manuscript assessed prevalence, clinical features, verification practices, and penicillin-cephalosporin cross-occurrence across multiple hospitals in China. METHODS: We used multicenter cross-sectional questionnaires in outpatient clinics at 22 institutions (n = 6070). Adjudication relied on routine records and prior testing performed in care. "Clinically-confirmed" allergy required a chart-documented reaction and/or a previously positive skin test; indeterminate entries were coded "uncertain." Cross-occurrence required confirmation for both classes. No de novo skin testing or drug provocation was performed by the study team; severe cutaneous adverse reactions were described without re-exposure. Descriptive statistics and χ² tests were used; logistic regression adjusted for prespecified covariates (age, sex, parental allergy history). RESULTS: Self-reported penicillin allergy was 21.9% (1331/6070); self-reported cephalosporin allergy was 4.5% (273/6070). Among respondents reporting cephalosporin allergy, 28.9% (79/273) had skin test positivity documented in routine care. Confirmed penicillin-cephalosporin cross-occurrence was 2.3% (140/6070). Testing practices varied across sites, and drug provocation was generally not implemented. CONCLUSIONS: In this multicenter survey adjudicated from routine care, clinically-confirmed β-lactam allergy was substantially lower than self-report, and confirmed penicillin-cephalosporin cross-occurrence was uncommon (2.3%). Clear confirmation criteria and phenotype-based triage using existing documentation can support safe delabeling and more appropriate first-line β-lactam use; the accompanying standard operating procedure provides procedural detail for replication.
Authors: Lanting Wang, Shengan Chen, Lin Lin, Ranran Dai, Xiaoqing Zhao, Shunming Xu, Shaoqing Yu, Wei Dong, Xiaojian Zhou, Xiaoyan Dong, Qiufang Qian, Weichun Ni, Yurong Gu, Haibo Ye, Chao Yuan, Xiaobo Zhang, Ling Yang, Lei Li, Meiling Jin, Dylan Lee, Li Ma, Xiaoqun Luo
Institutions: Fudan University, Huashan Hospital, Shanghai Jiao Tong University, Ruijin Hospital, Pudong New Area People's Hospital, Tongji University, Tongji Hospital, Shanghai First People's Hospital, Shanghai Children's Hospital, Shanghai Xuhui Central Hospital, Eye & ENT Hospital of Fudan University, Shanghai Sixth People's Hospital, Shanghai Skin Disease Hospital, Children's Hospital of Fudan University, XinHua Hospital, Zhongshan Hospital, Royal Society of Medicine
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,900
Awards: G1495917546, G8905907822
OpenAlex ID: W4414521211