Eric Macy1. 1. Southern California Permanente Medical Group, Department of Allergy, San Diego Medical Center, San Diego, California, USA.
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.
PURPOSE OF REVIEW: Unverified penicillinallergy is being increasingly recognized as a public health concern. The ideal protocol for verifying true clinically significant IgE-mediated penicillinallergy 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 penicillinallergy. RECENT FINDINGS:Penicillinallergy can be safely evaluated at this time, in patients with an appropriate clinical history of penicillinallergy, 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 penicillinallergy 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.
Authors: Rashmeet Bhogal; Abid Hussain; Ariyur Balaji; William H Bermingham; John F Marriott; Mamidipudi T Krishna Journal: Int J Clin Pharm Date: 2021-01-13
Authors: Sigrun Eick; Jasmin Nydegger; Walter Bürgin; Giovanni E Salvi; Anton Sculean; Christoph Ramseier Journal: Clin Oral Investig Date: 2018-02-21 Impact factor: 3.573
Authors: David Vyles; James W Antoon; Allison Norton; Cosby A Stone; Jason Trubiano; Alexandra Radowicz; Elizabeth J Phillips Journal: Ann Allergy Asthma Immunol Date: 2020-03-26 Impact factor: 6.347
Authors: I I Decuyper; E A Mangodt; A L Van Gasse; K Claesen; A Uyttebroek; M Faber; V Sabato; C H Bridts; C Mertens; M M Hagendorens; L S De Clerck; Didier G Ebo Journal: Drugs R D Date: 2017-06