#PENICILLIN ALLERGY CROSS REACTIVITY SKIN#

Clinicians performing penicillin allergy evaluation need to identify what methods are supported by their available resources.Ĭonclusions and Relevance Many patients report they are allergic to penicillin but few have clinically significant reactions.

#PENICILLIN ALLERGY CROSS REACTIVITY SKIN#

Moderate-risk patients can be evaluated with penicillin skin testing, which carries a negative predictive value that exceeds 95% and approaches 100% when combined with amoxicillin challenge.

Direct amoxicillin challenge is appropriate for patients with low-risk allergy histories. Broad-spectrum antimicrobial agents also increase the risk of developing Clostridium difficile (also known as Clostridioides difficile) infection. The goals of antimicrobial stewardship are undermined when reported allergy to penicillin leads to the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance, including increased risk of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. A high-risk history includes patients who have had anaphylaxis, positive penicillin skin testing, recurrent penicillin reactions, or hypersensitivities to multiple β-lactam antibiotics. A moderate-risk history includes urticaria or other pruritic rashes and reactions with features of IgE-mediated reactions. Although many patients report that they are allergic to penicillin, clinically significant IgE-mediated or T lymphocyte–mediated penicillin hypersensitivity is uncommon (10 years) unknown reactions without features suggestive of an IgE-mediated reaction.

Observations Approximately 10% of the US population has reported allergies to the β-lactam agent penicillin, with higher rates reported by older and hospitalized patients. Many patients report allergies to these drugs that limit their use, resulting in the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance and adverse events. Non-IgE-mediated hypersensitivity reactions (maculopapular rash, acute interstitial nephritis, immune-mediated hepatitis) have been reported with anti-staphylococcal penicillins (e.g. Importance β-Lactam antibiotics are among the safest and most effective antibiotics. The rate of cross-reactivity between a penicillin and cephalosporin due to antibody recognition is <2 in those who are skin test positive <1 in patients not skin tested.

Penicillin allergy cross reactivity