Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Cephalosporin allergy: Clinical manifestations and diagnosis

Antonino Romano, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD


Cephalosporins are among the most commonly-used antibiotics in the treatment of routine infections, and their use is increasing over time [1-3]. Cephalosporins can cause a range of hypersensitivity reactions, from mild, delayed-onset cutaneous reactions to life-threatening anaphylaxis in patients with immunoglobulin E (IgE)-mediated allergy [4-8].

This topic reviews the clinical manifestations, pathogenesis, and diagnosis of hypersensitivity reactions to cephalosporins. Issues of cross reactivity between cephalosporins, penicillins, and related drugs, and the subsequent use of cephalosporins and related antibiotics in patients with cephalosporin or penicillin allergy, are discussed elsewhere. (See "Cephalosporin-allergic patients: Subsequent use of cephalosporins and related antibiotics" and "Allergy evaluation for immediate penicillin allergy: Skin test-based diagnostic strategies and cross-reactivity with other beta-lactam antibiotics".)


Reactions to cephalosporins may be divided as follows [9]:

Immediate reactions, which develop within 1 hour after administration

Nonimmediate reactions, which develop >1 hour after administration

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 17, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA 1995; 273:214.
  2. Cars O, Mölstad S, Melander A. Variation in antibiotic use in the European Union. Lancet 2001; 357:1851.
  3. Ferech M, Coenen S, Malhotra-Kumar S, et al. European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe. J Antimicrob Chemother 2006; 58:401.
  4. Norrby SR. Side effects of cephalosporins. Drugs 1987; 34 Suppl 2:105.
  5. Kelkar PS, Li JT. Cephalosporin allergy. N Engl J Med 2001; 345:804.
  6. Romano A, Torres MJ, Namour F, et al. Immediate hypersensitivity to cephalosporins. Allergy 2002; 57 Suppl 72:52.
  7. Madaan A, Li JT. Cephalosporin allergy. Immunol Allergy Clin North Am 2004; 24:463.
  8. Guéant JL, Guéant-Rodriguez RM, Viola M, et al. IgE-mediated hypersensitivity to cephalosporins. Curr Pharm Des 2006; 12:3335.
  9. Romano A, Demoly P. Recent advances in the diagnosis of drug allergy. Curr Opin Allergy Clin Immunol 2007; 7:299.
  10. Spruill FG, Minette LJ, Sturner WQ. Two surgical deaths associated with cephalothin. JAMA 1974; 229:440.
  11. Hoffman DR, Hudson P, Carlyle SJ, Massello W 3rd. Three cases of fatal anaphylaxis to antibiotics in patients with prior histories of allergy to the drug. Ann Allergy 1989; 62:91.
  12. Pumphrey RS, Davis S. Under-reporting of antibiotic anaphylaxis may put patients at risk. Lancet 1999; 353:1157.
  13. Trani N, Bonetti LR, Gualandri G, Barbolini G. Immediate anaphylactic death following antibiotics injection: splenic eosinophilia easily revealed by pagoda red stain. Forensic Sci Int 2008; 181:21.
  14. Tsujikawa K, Kuwayama K, Miyaguchi H, et al. A fatal case of suspected anaphylaxis with cefoperazone and sulbactam: LC-MS analysis. J Forensic Sci 2008; 53:226.
  15. Riezzo I, Bello S, Neri M, et al. Ceftriaxone intradermal test-related fatal anaphylactic shock: a medico-legal nightmare. Allergy 2010; 65:130.
  16. Romano A, Gaeta F, Valluzzi RL, et al. Diagnosing hypersensitivity reactions to cephalosporins in children. Pediatrics 2008; 122:521.
  17. Thiella G, Bucci L, Agrati AM, Palmieri G. Nonfatal anaphylactic shock following an unusual sensitization. J Occup Med 1989; 31:490.
  18. Yarbrough JA, Moffitt JE, Brown DA, Stafford CT. Cimetidine in the treatment of refractory anaphylaxis. Ann Allergy 1989; 63:235.
  19. VanArsdel PP Jr. Allergy to cephalosporins. JAMA 1991; 265:2254.
  20. Pepys J, Pepys EO, Baldo BA, Whitwam JG. Anaphylactic/anaphylactoid reactions to anaesthetic and associated agents. Skin prick tests in aetiological diagnosis. Anaesthesia 1994; 49:470.
  21. Marcos Bravo C, Luna Ortiz I, González Vázquez R. Hypersensitivity to cefuroxime with good tolerance to other betalactams. Allergy 1995; 50:359.
  22. Romano A, Quaratino D, Aimone-Gastin I, et al. Cephalosporin allergy: Characterization of unique and cross-reaction cephalosporin antigens. Int J Immunopathol Pharmacol 1997; 10:Suppl 2:187.
  23. Romano A, Quaratino D, Venuti A, et al. Selective type-1 hypersensitivity to cefuroxime. J Allergy Clin Immunol 1998; 101:564.
  24. Grouhi M, Hummel D, Roifman CM. Anaphylactic reaction to oral cefaclor in a child. Pediatrics 1999; 103:e50.
  25. Romano A, Quaratino D, Venemalm L, et al. A case of IgE-mediated hypersensitivity to ceftriaxone. J Allergy Clin Immunol 1999; 104:1113.
  26. Romano A, Piunti E, Di Fonso M, et al. Selective immediate hypersensitivity to ceftriaxone. Allergy 2000; 55:415.
  27. Demoly P, Messaad D, Sahla H, et al. Immediate hypersensitivity to ceftriaxone. Allergy 2000; 55:418.
  28. Bernardini R, Novembre E, Lombardi E, et al. Long persistence of IgE antibody to cefaclor. Allergy 2000; 55:984.
  29. Romano A, Mayorga C, Torres MJ, et al. Immediate allergic reactions to cephalosporins: cross-reactivity and selective responses. J Allergy Clin Immunol 2000; 106:1177.
  30. Romano A, Di Fonso M, Artesani MC, et al. Selective immediate hypersensitivity to ceftazidime. Allergy 2001; 56:84.
  31. Prosser DP, Gompels M. Anaphylactic shock due to cefuroxime in a patient taking penicillin prophylaxis. Paediatr Anaesth 2002; 12:73.
  32. Sáenz de San Pedro B, Mayorga C, Torres MJ, et al. Boosted IgE response after anaphylaxis reaction to cefuroxime with cross-reactivity with cefotaxime. Ann Allergy Asthma Immunol 2002; 89:101.
  33. Ernst MR, van Dijken PJ, Kabel PJ, Draaisma JM. Anaphylaxis after first exposure to ceftriaxone. Acta Paediatr 2002; 91:355.
  34. Baumgartner-Bonnevay C, Choquet-Kastylevsky G, Putet G, et al. [Anaphylactic shock associated with ceftriaxone therapy in a newborn]. Arch Pediatr 2002; 9:1050.
  35. Atanasković-Marković M, Gavrović-Jankulović M, Cirković Velicković T, et al. Type-I hypersensitivity to ceftriaxone and cross-reactivity with cefalexin and ampicillin. Allergy 2003; 58:537.
  36. Poston SA, Jennings HR, Poe KL. Cefazolin tolerance does not predict ceftriaxone hypersensitivity: unique side chains precipitate anaphylaxis. Pharmacotherapy 2004; 24:668.
  37. Romano A, Guéant-Rodriguez RM, Viola M, et al. Diagnosing immediate reactions to cephalosporins. Clin Exp Allergy 2005; 35:1234.
  38. Butler RH, Gupta R. Postcoital allergic reaction in a woman. J Emerg Med 2005; 28:153.
  39. Worthley DL, Gillis D, Kette F, Smith W. Radiocontrast anaphylaxis with failure of premedication. Intern Med J 2005; 35:58.
  40. Antunez C, Blanca-Lopez N, Torres MJ, et al. Immediate allergic reactions to cephalosporins: evaluation of cross-reactivity with a panel of penicillins and cephalosporins. J Allergy Clin Immunol 2006; 117:404.
  41. Hasdenteufel F, Luyasu S, Renaudin JM, et al. Anaphylactic shock associated with cefuroxime axetil: structure-activity relationships. Ann Pharmacother 2007; 41:1069.
  42. Khan R, Anastasakis E, Kadir RA. Anaphylactic reaction to ceftriaxone in labour. An emerging complication. J Obstet Gynaecol 2008; 28:751.
  43. Novembre E, Mori F, Pucci N, et al. Cefaclor anaphylaxis in children. Allergy 2009; 64:1233.
  44. Varela Losada S, González de la Cuesta C, Alvarez-Eire MG, González González C. Immediate-type allergic reaction to cefuroxime: cross-reactivity with other cephalosporins, and good tolerance to ceftazidime. J Investig Allergol Clin Immunol 2009; 19:164.
  45. Ilhan E, Güvenç TS, Poyraz E, et al. Kounis Syndrome secondary to cefuroxime axetil use in an asthmatic patient. Int J Cardiol 2009; 137:e67.
  46. Somech R, Weber EA, Lavi S. Evaluation of immediate allergic reactions to cephalosporins in non-penicillin-allergic patients. Int Arch Allergy Immunol 2009; 150:205.
  47. Caimmi S, Galéra C, Bousquet-Rouanet L, et al. Safety of cefuroxime as an alternative in patients with a proven hypersensitivity to penicillins: a DAHD cohort survey. Int Arch Allergy Immunol 2010; 153:53.
  48. Barnett AS, Hirshman CA. Anaphylactic reaction to cephapirin during spinal anesthesia. Anesth Analg 1979; 58:337.
  49. Bloomberg RJ. Cefotetan-induced anaphylaxis. Am J Obstet Gynecol 1988; 159:125.
  50. Mizutani H, Ohyanagi S, Shimizu M. Anaphylaxis from cefotiam hexetil hydrochloride (CTM-HE) in an atopic nurse. Clin Exp Dermatol 1996; 21:246.
  51. Nordt SP, Cantrell FL, Rodriguez GJ. Anaphylactic reaction to dermal exposure to cephalexin. Am J Emerg Med 1999; 17:492.
  52. Romano A, Torres MJ, Mayorga C, et al. Allergy to two drugs in a patient. Allergy 2001; 56:786.
  53. Orhan F, Odemis E, Yaris N, et al. A case of IgE-mediated hypersensitivity to cefepime. Allergy 2004; 59:239.
  54. Romano A, Viola M, Guéant-Rodriguez RM, et al. Selective immediate hypersensitivity to cefodizime. Allergy 2005; 60:1545.
  55. Kaplan K, Weinstein L. Anaphylaxis to cephaloridine in a nurse who prepared solutions of the drug. JAMA 1967; 200:75.
  56. Scholand JF, Tennenbaum JI, Cerilli GJ. Anaphylaxis to cephalothin in a patient allergic to penicillin. JAMA 1968; 206:130.
  57. Saleh Y, Tischler E. Severe anaphylactic reaction to intravenous cephaloridine in a pregnant patient. Med J Aust 1974; 2:490.
  58. Tadokoro K, Niimi N, Ohtoshi T, et al. Cefotiam-induced IgE-mediated occupational contact anaphylaxis of nurses; case reports, RAST analysis, and a review of the literature. Clin Exp Allergy 1994; 24:127.
  59. Konno R, Nagase S. Anaphylactic reaction to cefazolin in pregnancy. J Obstet Gynaecol (Tokyo 1995) 1995; 21:577.
  60. Warrington RJ, McPhillips S. Independent anaphylaxis to cefazolin without allergy to other beta-lactam antibiotics. J Allergy Clin Immunol 1996; 98:460.
  61. Fujita Y, Chikamitsu M, Kimura M, et al. An anaphylactic reaction possibly associated with an intraoperative coronary artery spasm during general anesthesia. J Clin Anesth 2001; 13:221.
  62. Jao MS, Cheng PJ, Shaw SW, Soong YK. Anaphylaxis to cefazolin during labor secondary to prophylaxis for group B Streptococcus: a case report. J Reprod Med 2006; 51:655.
  63. Tayman C, Mete E, Bayrak O, et al. Unexpected cefazolin anaphylaxis in a 5-month-old girl. Pediatr Emerg Care 2008; 24:344.
  64. Romano A, Gaeta F, Valluzzi RL, et al. IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of penicillins, monobactams, and carbapenems. J Allergy Clin Immunol 2010; 126:994.
  65. Rothschild PD, Doty DB. Cephalothin reaction after penicillin sensitization. JAMA 1966; 196:372.
  66. Blanca M, Vega JM, Garcia J, et al. New aspects of allergic reactions to betalactams: crossreactions and unique specificities. Clin Exp Allergy 1994; 24:407.
  67. Pham NH, Baldo BA. beta-Lactam drug allergens: fine structural recognition patterns of cephalosporin-reactive IgE antibodies. J Mol Recognit 1996; 9:287.
  68. Baldo BA. Penicillins and cephalosporins as allergens--structural aspects of recognition and cross-reactions. Clin Exp Allergy 1999; 29:744.
  69. Blanca M, Mayorga C, Torres MJ, et al. Side-chain-specific reactions to betalactams: 14 years later. Clin Exp Allergy 2002; 32:192.
  70. Nagakura N, Shimizu T, Masuzawa T, Yanagihara Y. Anti-cephalexin monoclonal antibodies and their cross-reactivities to cephems and penams. Int Arch Allergy Appl Immunol 1990; 93:126.
  71. Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics 2005; 115:1048.
  72. Lammintausta K, Kortekangas-Savolainen O. The usefulness of skin tests to prove drug hypersensitivity. Br J Dermatol 2005; 152:968.
  73. Romano A, Gaeta F, Valluzzi RL, et al. Diagnosing nonimmediate reactions to cephalosporins. J Allergy Clin Immunol 2012; 129:1166.
  74. Pichler WJ. Delayed drug hypersensitivity reactions. Ann Intern Med 2003; 139:683.
  75. VanArsdel PP Jr. Drug reactions: allergy and near-allergy. Ann Allergy 1986; 57:305.
  76. Shiohara T, Kano Y. A complex interaction between drug allergy and viral infection. Clin Rev Allergy Immunol 2007; 33:124.
  77. Yerushalmi J, Zvulunov A, Halevy S. Serum sickness-like reactions. Cutis 2002; 69:395.
  78. Yawalkar N, Reimers A, Hari Y, et al. Drug-induced linear IgA bullous dermatosis associated with ceftriaxone- and metronidazole-specific T cells. Dermatology 1999; 199:25.
  79. Ozkaya E, Mirzoyeva L, Jhaish MS. Ceftriaxone-induced fixed drug eruption: first report. Am J Clin Dermatol 2008; 9:345.
  80. Murray KM, Camp MS. Cephalexin-induced Stevens-Johnson syndrome. Ann Pharmacother 1992; 26:1230.
  81. Narayanan VS, Mamatha GP, Ashok L, Rajashekar N. Steven Johnson syndrome due to I.V Ceftriaxone--a case report. Indian J Dent Res 2003; 14:220.
  82. Lam A, Randhawa I, Klaustermeyer W. Cephalosporin induced toxic epidermal necrolysis and subsequent penicillin drug exanthem. Allergol Int 2008; 57:281.
  83. Barbaud A, Collet E, Milpied B, et al. A multicentre study to determine the value and safety of drug patch tests for the three main classes of severe cutaneous adverse drug reactions. Br J Dermatol 2013; 168:555.
  84. Gonzalo-Garijo MA, Rodríguez-Nevado I, de Argila D. Patch tests for diagnosis of delayed hypersensitivity to cephalosporins. Allergol Immunopathol (Madr) 2006; 34:39.
  85. Young EJ, Fainstein V, Musher DM. Drug-induced fever: cases seen in the evaluation of unexplained fever in a general hospital population. Rev Infect Dis 1982; 4:69.
  86. Mastella G, Agostini M, Barlocco G, et al. Alternative antibiotics for the treatment of Pseudomonas infections in cystic fibrosis. J Antimicrob Chemother 1983; 12 Suppl A:297.
  87. Platt R. Adverse effects of third-generation cephalosporins. J Antimicrob Chemother 1982; 10 Suppl C:135.
  88. Sanders CV, Greenberg RN, Marier RL. Cefamandole and cefoxitin. Ann Intern Med 1985; 103:70.
  89. Akcam FZ, Aygun FO, Akkaya VB. DRESS like severe drug rash with eosinophilia, atypic lymphocytosis and fever secondary to ceftriaxone. J Infect 2006; 53:e51.
  90. Suswardana, Hernanto M, Yudani BA, et al. DRESS syndrome from cefadroxil confirmed by positive patch test. Allergy 2007; 62:1216.
  91. Fujiwaki T, Yoshikawa T, Urashima R, Ishioka C. Drug rash with eosinophilia and systemic symptoms induced by cefotaxime and ampicillin. Pediatr Int 2008; 50:406.
  92. Garnier A, El Marabet el H, Kwon T, et al. Acute renal failure in a 3-year-old child as part of the drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome following hepatitis A. Pediatr Nephrol 2008; 23:667.
  93. Blanca M, Romano A, Torres MJ, et al. Update on the evaluation of hypersensitivity reactions to betalactams. Allergy 2009; 64:183.
  94. Torres MJ, Blanca M, Fernandez J, et al. Diagnosis of immediate allergic reactions to beta-lactam antibiotics. Allergy 2003; 58:961.
  95. Igea JM, Fraj J, Davila I, et al. Allergy to cefazolin: study of in vivo cross reactivity with other betalactams. Ann Allergy 1992; 68:515.
  96. Weber EA. Cefazolin specific side chain hypersensitivity. J Allergy Clin Immunol 1996; 98:849.
  97. Atanasković-Marković M, Cirković Velicković T, Gavrović-Jankulović M, et al. A case of selective IgE-mediated hypersensitivity to ceftibuten. Allergy 2005; 60:1454.
  98. Gaig P, San Miguel MM, Enrique E, García-Ortega P. Selective type-1 hypersensitivity to cefixime. Allergy 1999; 54:901.
  99. Moreno E, Dávila I, Laffond E, et al. Selective immediate hypersensitivity to cefepime. J Investig Allergol Clin Immunol 2007; 17:52.
  100. Pipet A, Veyrac G, Wessel F, et al. A statement on cefazolin immediate hypersensitivity: data from a large database, and focus on the cross-reactivities. Clin Exp Allergy 2011; 41:1602.
  101. Yoon SY, Park SY, Kim S, et al. Validation of the cephalosporin intradermal skin test for predicting immediate hypersensitivity: a prospective study with drug challenge. Allergy 2013; 68:938.
  102. The diagnosis and management of anaphylaxis. Joint Task Force on Practice Parameters, American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. J Allergy Clin Immunol 1998; 101:S465.
  103. Empedrad R, Darter AL, Earl HS, Gruchalla RS. Nonirritating intradermal skin test concentrations for commonly prescribed antibiotics. J Allergy Clin Immunol 2003; 112:629.
  104. Testi S, Severino M, Iorno ML, et al. Nonirritating concentration for skin testing with cephalosporins. J Investig Allergol Clin Immunol 2010; 20:171.
  105. Barbaud A, Reichert-Penetrat S, Tréchot P, et al. The use of skin testing in the investigation of cutaneous adverse drug reactions. Br J Dermatol 1998; 139:49.
  106. Brockow K, Romano A, Blanca M, et al. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy 2002; 57:45.
  107. Zhao Z, Baldo BA, Rimmer J. beta-Lactam allergenic determinants: fine structural recognition of a cross-reacting determinant on benzylpenicillin and cephalothin. Clin Exp Allergy 2002; 32:1644.
  108. Harle DG, Baldo BA. Drugs as allergens: an immunoassay for detecting IgE antibodies to cephalosporins. Int Arch Allergy Appl Immunol 1990; 92:439.
  109. Sanz ML, Gamboa PM, Antépara I, et al. Flow cytometric basophil activation test by detection of CD63 expression in patients with immediate-type reactions to betalactam antibiotics. Clin Exp Allergy 2002; 32:277.
  110. Torres MJ, Padial A, Mayorga C, et al. The diagnostic interpretation of basophil activation test in immediate allergic reactions to betalactams. Clin Exp Allergy 2004; 34:1768.
  111. Ebo DG, Sainte-Laudy J, Bridts CH, et al. Flow-assisted allergy diagnosis: current applications and future perspectives. Allergy 2006; 61:1028.
  112. Abuaf N, Rostane H, Rajoely B, et al. Comparison of two basophil activation markers CD63 and CD203c in the diagnosis of amoxicillin allergy. Clin Exp Allergy 2008; 38:921.
  113. De Week AL, Sanz ML, Gamboa PM, et al. Diagnosis of immediate-type beta-lactam allergy in vitro by flow-cytometric basophil activation test and sulfidoleukotriene production: a multicenter study. J Investig Allergol Clin Immunol 2009; 19:91.
  114. Executive summary of disease management of drug hypersensitivity: a practice parameter. Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology, the American Academy of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1999; 83:665.
  115. Aberer W, Bircher A, Romano A, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003; 58:854.
  116. Pichichero ME, Pichichero DM. Diagnosis of penicillin, amoxicillin, and cephalosporin allergy: reliability of examination assessed by skin testing and oral challenge. J Pediatr 1998; 132:137.
  117. Romano A, Blanca M, Torres MJ, et al. Diagnosis of nonimmediate reactions to beta-lactam antibiotics. Allergy 2004; 59:1153.
  118. Romano A, Caubet JC. Antibiotic allergies in children and adults: from clinical symptoms to skin testing diagnosis. J Allergy Clin Immunol Pract 2014; 2:3.
  119. Romano A, Pietrantonio F, Di Fonso M, Venuti A. Delayed hypersensitivity to cefuroxime. Contact Dermatitis 1992; 27:270.
  120. Martin JA, Alonso MD, Lázaro M, et al. Delayed allergic reaction to cefonicid. Ann Allergy 1994; 72:341.
  121. San Miguel MM, Gaig P, Bartra J, García-Ortega P. Postoperative rash to ceftriaxone. Allergy 2000; 55:977.
  122. Romano A, Di Fonso M, Artesani MC, et al. Delayed hypersensitivity to cefotetan. Allergy 2001; 56:260.
  123. Romano A, Torres MJ, Di Fonso M, et al. Delayed hypersensitivity to cefazolin: report on a case involving lymphocyte transformation studies with different cephalosporins. Ann Allergy Asthma Immunol 2001; 87:238.
  124. Kudva-Patel V, White E, Karnani R, et al. Drug reaction to ceftriaxone in a child with X-linked agammaglobulinemia. J Allergy Clin Immunol 2002; 109:888.
  125. Borch JE, Bindslev-Jensen C. Full-course drug challenge test in the diagnosis of delayed allergic reactions to penicillin. Int Arch Allergy Immunol 2011; 155:271.
  126. Blanca-López N, Zapatero L, Alonso E, et al. Skin testing and drug provocation in the diagnosis of nonimmediate reactions to aminopenicillins in children. Allergy 2009; 64:229.
  127. Schnyder B, Pichler WJ. Nonimmediate drug allergy: diagnostic benefit of skin testing and practical approach. J Allergy Clin Immunol 2012; 129:1170.
  128. Blanca M, Torres MJ, García JJ, et al. Natural evolution of skin test sensitivity in patients allergic to beta-lactam antibiotics. J Allergy Clin Immunol 1999; 103:918.
  129. Romano A, Gaeta F, Valluzzi RL, et al. Natural evolution of skin-test sensitivity in patients with IgE-mediated hypersensitivity to cephalosporins. Allergy 2014; 69:806.