Get a clinical history of immediate allergic reaction to a cephalosporin.

Then do testing (specific IgE, skin prick testing or intradermal testing if available) to suspected beta-lactams, including the index cephalosporin.

If negative to index cephalosporin, do a graded challenge to the index cephalosporin.

If positive to index cephalosporin but negative to other beta-lactams, do a graded challenge to an alternative beta-lactam found negative on testing and with a similar R side chain structure.

If positive to index cephalosporin and other beta-lactams with a similar R side chain, do a graded challenge to an alternative beta-lactam found negative on testing and with a different R side chain structure.

If positive to all beta-lactams, do not challenge.

 

Note: This is an accessible text version of Figure 3 as shown in the article: ‘Cephalosporin allergy’ label is misleading