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Retrospective observational study of penicillin cross-sensitivity in patients with confirmed perioperative allergic hypersensitivity reactions to cefazolin.
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  • Karen Pedersen,
  • Johan van Schalkwyk,
  • Maia Brewerton,
  • Anthony Jordan,
  • Peter Cooke
Karen Pedersen
Te Whatu Ora Health New Zealand Te Toka Tumai Auckland

Corresponding Author:[email protected]

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Johan van Schalkwyk
Te Whatu Ora Health New Zealand Te Toka Tumai Auckland
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Maia Brewerton
Te Whatu Ora Health New Zealand Te Toka Tumai Auckland
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Anthony Jordan
Te Whatu Ora Health New Zealand Te Toka Tumai Auckland
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Peter Cooke
Te Whatu Ora Health New Zealand Te Toka Tumai Auckland
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Abstract

Concern about possible cross sensitivity between cefazolin and penicillin leads to restrictions on the use of penicillin in patients with cefazolin hypersensitivity reactions and no history of penicillin allergy. Our study aims to document the prevalence of penicillin cross sensitivity in this patient cohort. Sixty-eight adult patients who were seen at our clinic with confirmed cefazolin hypersensitivity reactions during the ten-year study period (2009–2018) were investigated for allergy to penicillin. Demonstration of penicillin tolerance was by a combination of penicillin skin testing, penicillin drug provocation testing (DPT) and community exposure to penicillin. There were no positive penicillin DPTs or reported reactions to penicillins in the community in our cohort. There were six false positive penicillin skin test results. Four patients were lost to follow up. We conclude that allergy to penicillin is uncommon in patients with confirmed hypersensitivity to cefazolin. Penicillin skin testing in this cohort of patients is time consuming, costly, and unreliable with a significant rate of false positives which may lead to patients being inappropriately labelled as penicillin allergic.