Clinical and diagnostic features of perioperative hypersensitivity to cefuroxime

INTRODUCTION: The Danish Anaesthesia Allergy Centre (DAAC) investigated 89 adult patients with suspected perioperative cefuroxime-associated hypersensitivity reactions between 2004 and 2013. The goals were to determine if the time to index reaction after cefuroxime exposure could be used to implicate cefuroxime as the cause of the reactions and explore different test modalities in diagnosing cefuroxime hypersensitivity.

METHOD: Skin tests, in vitro tests, and titrated provocations were used to determine cefuroxime hypersensitivity. Patients were deemed cefuroxime positive on the basis of at least 2 positive tests and/or a positive provocation.

RESULTS: One or more tests were positive for cefuroxime in 24/89 (27.0%) patients. One was only specific IgE-positive and was deemed cefuroxime negative. Twenty-three (25.8%) were deemed cefuroxime positive. There were 4 specific IgE-, 4 histamine release test-, 13 skin test-, and 14 provocation positive patients. There were 8 (34.8%) patients who were only provocation positive. Data on time to index reaction after cefuroxime exposure was available for 80 patients (22 in the positive group and 58 in the negative group), 22/22 (100%) of positive patients reacted in < 15 minutes versus only 38/58 (65.5%) of negative patients.

CONCLUSION: All patients with confirmed hypersensitivity to cefuroxime reacted within 15 minutes of administration, but so did 65.5% of cefuroxime negative patients, making timing of administration an unreliable predictor of causation in the perioperative setting. Provocations were always positive when carried out in skin test positive patients; however 8 patients had positive provocations only, highlighting the need for provocation in skin test negative patients. This article is protected by copyright. All rights reserved.