EDITORIAL
Penicillin allergy: updating the role of skin testing in diagnosis
Correspondence to:
Dr Penny Fitzharris, Auckland City Hospital, Auckland, New Zealand; pennyf@adhb.govt.nz
Keywords: β-lactams; drug hypersensitivity; oral challenge; penicillins; skin test
| The first 150 words of the full text of this article appear below. |
Studies of fatal anaphylaxis in the UK have shown that widely prescribed β-lactam antibiotics are responsible for 26% of fatal drug induced anaphylaxis and 11% of all cases of fatal anaphylaxis.1 A history of allergy to a penicillin or cephalosporin, common in both community and hospitalised patients, therefore cannot be ignored and must always be recorded. However, there are numerous reports that four in five individuals who believe they are allergic to penicillins will in fact tolerate penicillin use, so for these patients the constraints on antibiotic choice, potentially resulting in less effective and more expensive treatment, are unnecessary. Drug allergy work-up is often cost effective, with a favourable risk:benefit ratio, but controversies have arisen recently regarding both the reagents and the protocols considered best practice for penicillin skin testing.
DECIDING WHO TO TEST
Several tests are available to detect penicillin specific IgE antibodies, the presence of which indicates a substantially increased risk of
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