For children with a history of a cephalosporin allergy who require another cephalosporin, two approaches may be considered: a graded challenge with a cephalosporin that does not share the same side chain determinant, or skin testing with the same or a different cephalosporin. A positive response suggests the presence of IgE-mediated allergy, and the value of a negative test is unknown. Skin testing with cephalosporins has not been standardized or validated.
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Hilary M. Haftel
The rheumatic diseases (collagen vascular or connective tissue diseases) of childhood are characterized by autoimmunity and inflammation, which may be localized or generalized. The classic rheumatic diseases of children include juvenile idiopathic arthritis (JIA), formerly called juvenile rheumatoid arthritis, systemic lupus erythematosus (SLE), and juvenile dermatomyositis (JDM). Vasculitis is a component of many rheumatic diseases. Musculoskeletal pain syndromes are a set of overlapping conditions characterized by poorly localized pain involving the extremities. Scleroderma, Behçet syndrome, and Sjögren syndrome are rare in childhood. The differential diagnosis of rheumatologic disorders typically includes infections, postinfectious processes, and malignancies (Table 86-1).