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Giornale Italiano di Dermatologia e Venereologia 2007 June;142(3):259-67

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: English

Penicillin allergy and the discrepancy between history and fact

Seitz B. S., Trautmann A.

Department of Dermatology, Venerology and Allergology University of Würzburg, Würzburg, Germany

Suspected penicillin allergy has reached an endemic frequency. Today, up to 10% of the general population report a history of penicillin allergy. In case of suspected penicillin allergy the treating physician has to use alternative antibiotics. Due to theoretically potential cross-reactivity usually all β-lactam drugs such as penicillins, penicillin derivatives and cephalospo-rins will be avoided and alternative antibiotics are prescribed. These include other classes of antibiotics e.g. macrolides, quinolones and glycopeptides with potentially more side effects and less efficacy, risk of development of antimicrobial resistances and increasing expenses of the medical care. Allergologic step-by-step diagnostic procedures show that at least 75% to 85% of patients with suspected penicillin allergy tolerate all β-lactams. Anamnestic statements of the patient, observations by physicians who are not familiar with allergic cutaneous symptoms or incomplete diagnostic investigations should not lead uncritically to the diagnosis penicillin allergy. A step-by-step allergologic investigation identifies patients with true penicillin allergy. After exclusion of penicillin allergy the majority of patients may receive the first-line antibiotic therapy with improvement of quality and efficacy.