Ceftriaxone intradermal test-related fatal anaphylactic shock: a medico-legal nightmare.

Allergic reactions to betalactams are the most common cause of adverse drug reactions mediated by specific immunological mechanisms (1). The diagnosis of betalactam allergic reactions is now well established and can be determined using the standardized diagnostic procedures of the European Network for Drug Allergy (ENDA) (2). Intradermal testing is done by the injection of 0.02–0.05 ml of the hapten solution, raising a small bleb that is marked initially. It should be performed on the volar forearm, although other skin areas can be used. Particular caution and testing, starting with 1000-fold dilutions of the stock reagents, should be used in patients who have experienced severe or life-threatening reactions such as anaphylaxis. Skin testing with betalactams should be performed under controlled conditions with emergency treatment available, as systemic side-effects may occur up to 10% of the patients being tested for drug allergy (3). Oral provocation tests are inducing far more systemic reactions than skin tests (4, 5)