Cookie Notice

This site uses cookies. By continuing to browse this site, you are agreeing to our use of cookies. Review our cookies information for more details.

OK
skip to main content

Cefdinir allergy

Question:

12/3/2018
I saw a 16 year-old for penicillin and cephalosporin allergy. When he was three to four years old while on Amoxil for otitis, he developed a rash (not urticarial) and was switched to Omnicef. On the last day of treatment he developed a similar total body rash as when he was on Amoxil but also had swollen lower extremeity joints. No meds given but the swelling lasted 2 weeks and he was unable to walk during that time. His Penicillin testing and challenge was negative. He was negative to prick and ID to all 3 generations of Cephalosporins. Is the next step to give a single dose oral challenge with Cefdinir?
 

Answer:

Delayed reactions to all antibiotics are a challenge as there are multiple potential mechanisms. It is unlikely that delayed reactions, particularly when associated with persistent joint pain, are related to IgE or type I hypersensitivity. Serum sickness hypersensitivity may be associated with synovitis. If the reactions are due to IgG or IgM or T cells, the negative beta lactam/penicillin IgE test and challenge would not provide sufficient reassurance to permit routine administration. Antibiotic patch testing is a consideration to evaluate delayed, T lymphocyte dependent drug reactions (1). I do not think your patient is at risk of anaphylaxis. Thus, the antibiotic of need could be administered at routine oral dose with close follow up. I do not think a graded challenge or single oral dose challenge is necessary. However, I would consider administering 3-4 days of an oral antibiotic in an attempt to exclude a delayed reaction. I would not use cefdinir in light of the prolonged joint pain. The other option would be to use an alternative class, depending on the infection.

In summary, I do not think specific-IgE is likely responsible for the reactions suffered by your patient. The negative specific-IgE testing does not exclude delayed reactions. I would avoid cefdinir but consider an alternative beta lactam for an oral trial of several days to ensure the lack of a delayed reaction. Antibiotic patch testing may be of value but the technique is not standardized.

1. Solensky R, Khan D. Drug allergy: An updated practice parameter. Annals Allergy Asthma Immunol 2010;105:273.e1-78.

I hope this information is of help to you and your practice.

All my best.
Dennis K. Ledford, MD, FAAAAI