Thank you for your inquiry.
Unfortunately, I am not aware of any case report of a patient with a previous history of Stevens-Johnson syndrome related to the administration of penicillin receiving a graded challenge to a cephalosporin. Thus, I do not think we have any evidence-based data to help you make a decision as to whether or not to proceed with a graded challenge to a cephalosporin in your patient. There is, however, a guideline (published by Therapeutic Guidelines) which deals with the issue of drug substitution in patients with a history of IgE-mediated and non-IgE-mediated reactions to penicillin. I have copied a link to this site below:
Source: Therapeutic Guidelines
I believe that your patient would fit their description of “A clear or vague history of DRESS, Stevens-Johnson syndrome, or variants.” The recommendation in this situation would be “Do not administer penicillin, a cephalosporin or a carbapenem.”
I would personally agree with this strategy, especially if there were other antibiotics available that might serve the same purpose.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.