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Immediate cephalosporin allergy is caused by IgE-mediated reactions, predominantly to R side chains, and cross reaction with the β-lactam ring in penicillins is uncommon. Although cross reactivity is rare, almost all electronic health record (EHR) systems warn that penicillin-allergic patients should not receive cephalosporins. This practice is problematic, because being labeled as allergic to β-lactams is associated with use of more-expensive broad-spectrum antibiotics, leading to higher healthcare costs and more nosocomial infections.
This cephalosporin warning was removed in the Kaiser Southern California healthcare system at the end of 2017, while the Kaiser Northern California system kept the warning in place. Approximately 4 million in…