A Perspective on Penicillin Allergy

Abstract

Clinical situations for which penicillin is indicated as the sole effective treatment are not infrequent and may be increasing in incidence. Penicillin allergy in these circumstances complicates their medical management. The proper evaluation of penicillin allergy is thus crucial to making decisions about alternative antibiotic therapy vs penicillin and the need for desensitization in allergic individuals. The combination of skin testing and assessment of the type of previous penicillin allergic reaction allows designation of patients into those at high risk and those at low risk for subsequent reactions. Penicillin allergy may also complicate the management of infections in which a cephalosporin is the preferred treatment. The available data on cross-reactivity and concurrent hypersensitivity involving these antibiotics and penicillin are incomplete. The current and past literature were reviewed in an attempt to develop practical treatment approaches and to identify clinical questions that need further investigation related to penicillin allergy.

Adverse Reactions to Isosulfan Blue During Selective Sentinel Lymph Node Dissection in Melanoma

“…In addition, adverse reactions to cephalosporins are thought to occur most frequently in patients who are known to be allergic to penicillin, because one-half or more of patients report penicillin allergy. [21][22][23] None of our three patients reported allergy to penicillin.…”

Anaphylactic shock in pregnancy: a case study and review of the literature

“…11 Penicillin anaphylaxis is reported to occur in 1-5/10 000 patients, with fatal anaphylactic reactions 1-2/100 000 treated. 12 While anaphylaxis is a relatively rare event in pregnancy, it can have significant adverse effects on the fetus, which are often recognized only after irreversible injury has occurred.…”

Perspectives on antibiotics for postoperative endophthalmitis prophylaxis: Potential role of moxifloxacin

“…Various studies 20,30 estimate that the prevalence of penicillin allergy ranges between 1% and 10%. Although there is some disagreement in the literature regarding cross-allergenicity between penicillin and cephalosporins, [30][31][32] severe anaphylactic reactions to intraocular and subconjunctival injections of cephalosporins have been reported in patients with a known and unknown allergy to penicillin. 33,34 Furthermore, from a mechanistic perspective, because cataract surgery causes a breakdown in the blood-aqueous barrier, even a small intracameral dose of cefuroxime could be postulated to lead to a serious hypersensitivity reaction in a susceptible patient.…”