Penicillin allergy: optimizing diagnostic protocols, public health implications, and future research needs. Issue 4 (August 2015)

• Record Type: Journal Article
• Authors: Macy, Eric
• Is Part Of: Current opinion in allergy and clinical immunology. Volume 15:Issue 4(2015:Aug.)
• Publication Date: 2015-08
• Subjects: adverse drug reaction -- drug provocation testing -- oral challenge -- penicillin allergy -- penicillin skin test; Allergy -- Periodicals; Clinical immunology -- Periodicals; Hypersensitivity; Immunity; Immune System Diseases; Allergy and Immunology; 616.079
• DOI: 10.1097/ACI.0000000000000173
• Languages: English
• ISSNs: 1528-4050

Abstract

Abstract : Purpose of review: Unverified penicillin allergy is being increasingly recognized as a public health concern. The ideal protocol for verifying true clinically significant IgE-mediated penicillin allergy needs to use only commercially available materials, be well tolerated and easy to perform in both the inpatient and outpatient settings, and minimize false-positive determinations. This review concentrates on articles published in 2013 and 2014 that present new data relating to the diagnosis and management of penicillin allergy . Recent findings: Penicillin allergy can be safely evaluated at this time, in patients with an appropriate clinical history of penicillin allergy, using only penicilloyl-poly-lysine and native penicillin G as skin test reagents, if an oral challenge with amoxicillin 250 mg, followed by 1 h of observation, is given to all skin test negative individuals. Summary: Millions of individuals falsely labeled with penicillin allergy need to be evaluated to safely allow them to use penicillin-class antibiotics and avoid morbidity associated with penicillin avoidance. Further research is needed to determine optimal protocol(s). There will still be a 1–2% rate of adverse reactions reported with all future therapeutic penicillin-class antibiotic use, even with optimal methods used to determine acute penicillin tolerance. Only a small minority of these new reactions will be IgE-mediated.