Abstract
Penicillin is the most common beta-lactam antibiotic allergy and the most common drug class allergy, reported in about 8 % of individuals using health care in the USA. Only about 1 % of individuals using health care in the USA have a cephalosporin allergy noted in their medical record, and other specific non-penicillin, non-cephalosporin beta-lactam allergies are even rarer. Most reported penicillin allergy is not associated with clinically significant IgE-mediated reactions after penicillin rechallenge. Un-verified penicillin allergy is a significant and growing public health problem. Clinically significant IgE-mediated penicillin allergy can be safely confirmed or refuted using skin testing with penicilloyl-poly-lysine and native penicillin G and, if skin test is negative, an oral amoxicillin challenge. Acute tolerance of an oral therapeutic dose of a penicillin class antibiotic is the current gold standard test for a lack of clinically significant IgE-mediated penicillin allergy. Cephalosporins and other non-penicillin beta-lactams are widely, safely, and appropriately used in individuals, even with confirmed penicillin allergy. There is little, if any, clinically significant immunologic cross-reactivity between penicillins and other beta-lactams. Routine cephalosporin skin testing should be restricted to research settings. It is rarely needed clinically to safely manage patients and has unclear predictive value at this time. The use of alternative cephalosporins, with different side chains, is acceptable in the setting of a specific cephalosporin allergy. Carbapenems and monobactams are also safely used in individuals with confirmed penicillin allergy. A certain predictable, but low, rate of adverse reactions will occur with all beta-lactam antibiotic use both pre- and post-beta-lactam allergy evaluations.
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Abbreviations
- ADR(s):
-
Adverse drug reaction(s)
- EHR:
-
Electronic health record
- KPSC:
-
Kaiser Permanente in Southern California
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
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Conflict of Interest
Eric Macy reports grants from ALK during the conduct of the study.
Human and Animal Rights and Informed Consent
All of the studies in this article performed by the author were reviewed and approved by the Kaiser Permanente Southern California Institutional Review Board.
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This article is part of the Topical Collection on Anaphylaxis and Drug Allergy
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Macy, E. Penicillin and Beta-Lactam Allergy: Epidemiology and Diagnosis. Curr Allergy Asthma Rep 14, 476 (2014). https://doi.org/10.1007/s11882-014-0476-y
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DOI: https://doi.org/10.1007/s11882-014-0476-y