Penicillin allergy: a practical approach to assessment and prescribing

Abstract

Penicillin allergies are not always lifelong. Approximately 50% are lost over five years A reaction to penicillin during a childhood infection is unlikely to be a true allergy Only 1–2% of patients with a confirmed penicillin allergy have an allergy to cephalosporins. In patients with a low risk of severe allergic reactions, cephalosporins are a relatively safe treatment option Patients with a history of delayed non-severe reactions, such as mild childhood rashes that occurred over 10 years ago, may be suitable for an oral rechallenge with low-dose penicillin. This should be done in a supervised hospital environment In many cases, with appropriate assessment and allergy testing, it may be possible to remove the penicillin allergy label

Keywords: beta-lactams; cephalosporins; hypersensitivity.

Fig. 1

Rates of cross-reactivity between beta-lactam antibiotics [Table: see text]

Fig. 2

Penicillin allergy assessment guide

Fig. 3

Suggested management of patients reporting hypersensitivity to penicillins in whom a beta-lactam antibiotic is the preferred drug