Breaking the barrier: Transforming the diagnosis and management of penicillin and cephalosporin allergy in China.

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.