Materiały źródłowe

• #1 Patient education: Allergy to penicillin and related antibiotics (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/allergy-to-penicillin-and-related-antibiotics-beyond-the-basics/print

  PENICILLIN ALLERGY OVERVIEW […] Overall, approximately 10 percent of people report some type of unwanted reaction to penicillin, and serious and even fatal allergic reactions do occur. However, most people who believe they are allergic can take penicillin without a problem, either because they were never truly allergic or because their allergy resolved over time. Among people with a convincing history of severe penicillin allergy, only approximately 20 percent will be allergic to penicillin a decade after their initial allergic reaction if they are not exposed to it again during this time period. […] Anyone who is allergic to one of the penicillins should be presumed to be allergic to all penicillins and should avoid the entire group, unless they have been specifically evaluated for this problem.

• #2 Do you really have a penicillin allergy? – Harvard Health

  https://www.health.harvard.edu/blog/do-you-really-have-a-penicillin-allergy-2019022616017

  Chances are, you or someone you know is one of the 10% of Americans with a documented penicillin allergy. […] People with a penicillin allergy history have their allergy disproved with allergy testing more than 90% of the time. […] True allergies can result from any medication. […] If a reaction to penicillin included skin redness, itching, rash, or swelling, there may have been a penicillin allergy, but these symptoms can also occur for other reasons. […] Even patients with severe penicillin allergy histories are often able to take penicillins safely again, because penicillin allergy often does not persist for life. […] Confirming or ruling out a penicillin allergy through allergy testing could justify the risk, or potentially avert it by allowing your doctor to prescribe beta-lactams.

• #3 Penicillin Allergy: Signs, Diagnosis & Treatment

  https://getcurex.com/allergens-and-symptoms/allergy-symptoms-immunotherapy-penicillin-and-related-antibiotics?srsltid=AfmBOop-IkLV6FDIRhVGNFYO-Z8fM-cOrL5uK1frEGG_HHL2Lw_PN-jH

  A penicillin allergy involves an immune response, resulting in symptoms such as hives, swelling, or anaphylaxis. These reactions can be severe and require immediate medical attention. […] Accurate diagnosis by an allergist can differentiate between the two, ensuring proper management and safety. […] Many individuals diagnosed with a penicillin allergy earlier in life may indeed outgrow the condition. Studies show that approximately 80% of people remain free of the allergy after about 10 years. […] It is important to undergo allergy testing before re-exposing oneself to penicillin, to confirm whether the allergy still exists. […] Your immune system gets desensitized to allergens, giving you long-term relief.

• #4 Penicillin allergy: a practical approach to assessment and prescribing

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6954877/

  Penicillin allergies are not always lifelong. Approximately 50% are lost over five years. […] 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. […] The assessment of penicillin allergy enables classification of phenotypes as either severe versus non-severe and immediate versus delayed. This is helpful in stratifying the risk of using alternative beta-lactam antibiotics. […] Non-immune-mediated adverse drug reactions (type A) are not true allergic reactions. Common examples are gastrointestinal symptoms, such as nausea, vomiting and diarrhoea. If a patient has been labelled as penicillin-allergic because of a type A reaction, this should not stop the prescribing of beta-lactam antibiotics and patients do not need to undergo allergy testing.

• #5 Penicillin allergy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/symptoms-causes/syc-20376222

  Penicillin allergy is an abnormal reaction of your immune system to the antibiotic drug penicillin. […] Therefore, an accurate diagnosis is needed when penicillin allergy is suspected to ensure the best treatment options in the future. […] See your doctor as soon as possible if you experience signs or symptoms of penicillin allergy. It’s important to understand and discuss what is an allergic reaction, what is a typical side effect and what you can tolerate in taking a medication. […] Call 911 or emergency medical help if you experience signs of a severe reaction or suspected anaphylaxis after taking penicillin.

• #6 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  A thorough exam and appropriate diagnostic tests are essential for an accurate diagnosis. A misdiagnosed penicillin allergy may result in the use of less-appropriate or more-expensive antibiotics. […] If your doctor determines that you have a penicillin allergy or likely allergy discontinuing the drug is the first step in treatment. […] Your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine such as diphenhydramine (Benadryl) that can block immune system chemicals activated during an allergic reaction. […] Either oral or injected corticosteroids may be used to treat inflammation associated with more-serious reactions. […] Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain blood pressure and support breathing.

• #7 Clinical Features of Penicillin Allergy | Antibiotic Prescribing and Use | CDC

  https://www.cdc.gov/antibiotic-use/hcp/clinical-signs/index.html

  Conduct a history and physical exam to confirm a true penicillin allergy (and when appropriate, skin test and challenge dose) before prescribing broad-spectrum antibiotics to a patient thought to be penicillin-allergic. […] Penicillin skin testing and challenge doses are reliable and useful methods for evaluating for IgE-mediated penicillin allergy. […] A positive result means the patient is likely to have a penicillin allergy. If negative, a skin test is usually followed by an oral penicillin class challenge (like amoxicillin) to safely rule out an IgE-mediated penicillin allergy. […] The current standard of care is to perform a skin test with the major determinant penicilloylpolylysine and commercially-available penicillin G. […] To rule out penicillin allergy, an oral challenge dose can be done after skin testing.

• #8 The Truth About Penicillin Allergy … And Why it’s Important to Get Tested – Allergy & Asthma Network

  https://allergyasthmanetwork.org/news/the-truth-about-penicillin-allergy-and-why-its-important-to-get-tested/

  Penicillin Allergy Testing is fast, accurate and safe […] If you think you or your child is allergic to penicillin, it’s important to get tested to find out for sure. […] If it’s determined you or your child are not truly allergic, then you can gain access to this important group of antibiotics, Dr. Ramsey says. […] Just think you can free yourself of the burden of carrying a penicillin allergy label everywhere you go while also not enabling a potential superbug. A win-win. […] It’s simple. In a doctor’s office or hospital, you undergo a skin prick test in which the needle barely penetrates the surface of the skin. A raised, reddish wheal at the sight of the prick indicates a positive test for an allergy. No wheal, rash or hives? You’re probably not allergic after all. […] Some doctors may follow up a negative skin prick test with an oral challenge usually a full dose of liquid penicillin. The oral challenge has two purposes: 1) it confirms your negative test, and 2) it eases the fear factor over taking penicillin should you not be allergic. Again, this should only be conducted in a doctor’s office or hospital.

• #9 Clinical Features of Penicillin Allergy | Antibiotic Prescribing and Use | CDC

  https://www.cdc.gov/antibiotic-use/hcp/clinical-signs/index.html

  Negative predictive value of skin testing with major and minor determinants is more than 95%, but nears 100% when followed by a challenge dose. […] A direct oral challenge without prior skin testing may also be performed in selected patients and can rule out penicillin allergy. […] Correctly identifying if your patient is actually penicillin-allergic can decrease these risks by reducing unnecessary use of broad-spectrum antibiotics.

• #10 Patient education: Allergy to penicillin and related antibiotics (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/allergy-to-penicillin-and-related-antibiotics-beyond-the-basics/print

  If skin testing is not available, options for people who may be allergic to penicillin include: […] Taking a different antibiotic […] Undergoing a challenge test […] Undergoing desensitization […] Challenge testing is usually done in an office setting, starting with a small dose of the antibiotic given by mouth. If the person tolerates the smaller dose, a larger dose is given every 30 to 60 minutes until they have signs of an allergic reaction or the full dose is given. If the person tolerates the full dose, they are not allergic to the antibiotic. […] Skin testing should be done by an allergist in an office or hospital setting. Testing usually takes approximately one hour to complete. The skin is pricked and injected with weak solutions of the various parts of penicillin and observed for a reaction. This may cause discomfort due to itching, although it is not painful.

• #11 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  A thorough exam and appropriate diagnostic tests are essential for an accurate diagnosis. A misdiagnosed penicillin allergy may result in the use of less-appropriate or more-expensive antibiotics. […] If your doctor determines that you have a penicillin allergy or likely allergy discontinuing the drug is the first step in treatment. […] Your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine such as diphenhydramine (Benadryl) that can block immune system chemicals activated during an allergic reaction. […] Either oral or injected corticosteroids may be used to treat inflammation associated with more-serious reactions. […] Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain blood pressure and support breathing.

• #12 Penicillin Allergy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26892

  Treatment for acute IgE mediated reaction to penicillin depends on severity. Patients presenting in acute anaphylaxis need to have immediate treatment with IM epinephrine (1 mg/ml) 0.3 mg to 0.5 mg every 5 to 15 minutes until resolution of symptoms. Adjunctive therapies include H1 and H2 antihistamines including diphenhydramine 25 mg to 50 mg intravenously (IV) and ranitidine 50 mg IV, respectively. Glucocorticoids should also be administered such as 125 mg methylprednisone. Patients with refractory symptoms should be treated with an infusion of epinephrine at 0.1 mcg/kg/minute. All patients presenting with acute anaphylaxis should be immediately placed on telemetry monitoring with large-bore IV for IVF resuscitation at 1 L to 2 L NS bolus. If patients are experiencing bronchospasm, albuterol 2.5 mg to 5 mg can also be considered. These patients require admission to the hospital. Patients with a resolution of symptoms after a period of observation are safe for discharge.

• #13 Penicillin Allergy – what do you need to know?

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/penicillin-allergy

  Penicillin AllergyPenicillins are widely used antibiotics that have important roles in treating bacterial infections. […] Treatment of these reactions usually involves an antihistamine and sometimes an oral or injected corticosteroid. […] These symptoms require immediate treatment with epinephrine and/or at the nearest emergency room or by calling Emergency Medical Services. Additional treatments may include albuterol to treat respiratory symptoms, IV fluids, and corticosteroids. […] If a penicillin is needed, a desensitization procedure can be performed under the care of an allergist / immunologist to temporarily allow the drug to be used.

• #14 Penicillin allergy: Definition, treatment, and more

  https://www.medicalnewstoday.com/articles/penicillin-allergy

  A penicillin allergy can cause symptoms such as hives, shortness of breath, and areas of swelling. In some cases, it may also lead to anaphylaxis, a life threatening condition that causes low blood pressures, a fast heartbeat, and faintness. […] Treatment of mild cases may involve taking an antihistamine, while severe cases may require emergency administration of epinephrine alongside other drugs. […] Treatment depends on the severity of the allergic reaction. Antihistamines are a class of medications doctors may prescribe in the first instance for mild rashes and itching. Examples include diphenhydramine (Benadryl) or cetirizine (Zyrtec). Topical steroid ointments, such as hydrocortisone, may also provide relief for non-hive rashes. […] In contrast, an anaphylaxis reaction is a life threatening event that necessitates immediate treatment. This involves someone having an epinephrine injection every 5-15 minutes until symptoms subside. Additionally, a person may need one of the following medications: Antihistamines: They may require an injection of an H1 antihistamine, such as diphenhydramine (Benadryl), or an H2 antihistamine, such as ranitidine (Zantac). Glucocorticoids: These are drugs that reduce inflammation. One example is methylprednisone (Medrol). Bronchodilators: This medication dilates the airways. Doctors use it to treat airway spasms. An example of this type of drug is Albuterol (Accuneb).

• #15 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication. […] For persons who have a positive skin test reactive to penicillin (either to the major or minor determinants), treatment with a -lactam antibiotic is not usually advised, and other effective antimicrobials should be used. […] Desensitization is required for persons who have a documented penicillin allergy and for whom no therapeutic alternatives exist (e.g., syphilis during pregnancy and persons with neurosyphilis). […] Patients who have a positive skin test should not receive -lactam drugs in the ambulatory setting and should be referred to an allergist or penicillin allergy expert for further evaluation. […] If treatment with penicillin or ceftriaxone is indicated, it can be administered safely.

• #16 Penicillin Allergy: Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/16624-penicillin-allergies

  A penicillin allergy is a common allergy. It occurs when your immune system reacts negatively to the antibiotic penicillin. An allergic reaction can be a medical emergency, so contact your healthcare provider or call 911 if symptoms are severe. […] Treatment for a penicillin allergy should be managed by your healthcare provider and could include: Immediately stopping further use of penicillin. Taking an antihistamine to reduce your allergic reaction symptoms (your provider will guide you on which antihistamine you should take). Taking a prescribed corticosteroid for severe swelling, inflammation or itching. Taking an injection of epinephrine from an emergency injector (either ones you carry, those found in first aid kits or those used in the emergency room) to treat severe anaphylaxis. […] Yes, there are alternative antibiotics available for you to take if you have a penicillin allergy. Notify your provider that you have an allergy to penicillin if they prescribe any medicine to you.

• #17

  https://www.nhstaysideadtc.scot.nhs.uk/Antibiotic%20site/penhypers.htm

  Patients with a history of Type I allergy clinically recognisable by features of urticaria, laryngeal oedema, bronchospasm, hypotension or local swelling within 72 hours of administration, or development of a pruritic rash (even after 72 hours) should NOT receive a penicillin. […] Patients with no evidence of Type I allergy to penicillin may be treated with any cephalosporin or beta lactam antibiotic for infections of any severity. […] Patients with symptoms suggestive of a Type I allergy should avoid cephalosporins and other beta-lactam antibiotics for mild or moderate infections when a suitable alternative exists. In life threatening infections, when use of a non-cephalosporin antibiotic would be sub-optimal, consider giving, under observation, a second or third generation cephalosporin (e.g. cefuroxime, ceftriaxone, ceftazidime).

• #18

  https://www.nhstaysideadtc.scot.nhs.uk/Antibiotic%20site/penhypers.htm

  Tetracyclines (e.g. doxycycline), quinolones (e.g. ciprofloxacin), macrolides (e.g. clarithromycin), aminoglycosides (e.g. gentamicin) and glycopeptides (e.g. vancomycin) are all unrelated to penicillins and are safe to use in the penicillin allergic patient. […] Always identify and document the nature of the reported allergy and drug name on the medicine chart and in the medical notes. The prescriber has the primary responsibility for ensuring that the allergy/sensitivity details are completed on all relevant medicine charts and medical notes.

• #19 Penicillin Allergy: Symptoms, Causes, & Treatment | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/penicillin-allergy

  Immediate Treatment of Allergic Reactions: The treatment of a penicillin allergy typically involves the following steps: Immediate disuse of penicillin, Taking a prescribed corticosteroid, such as cortisone or prednisone, to reduce itching and swelling, Taking an antihistamine, such as loratadine or cetirizine, to control allergy symptoms. […] Epinephrine is required to counteract anaphylaxis in emergency situations. This can be self-administered by means of a portable injector or obtained in an emergency medical facility. […] Long-term Treatment and Alternatives: There are alternative antibiotics for treating bacterial infections for persons with a penicillin allergy. Among these drugs are: Ciprofloxacin, Clarithromycin, Doxycycline, Gentamicin. […] A second alternative for persons with a penicillin allergy is drug desensitization. You may be able to desensitize your immune system to the presence of penicillin through a program of introducing progressively larger amounts of penicillin over an extended period. If you can tolerate a full dosage of penicillin delivered gradually, you may be able to use the drug in the future to combat infection.

• #20 Penicillin allergy: a practical approach to assessment and prescribing – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/penicillin-allergy-a-practical-approach-to-assessment-and-prescribing.html

  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. […] 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. […] While penicillin allergies can be life-threatening, it is important to ensure that all patients with a recorded penicillin allergy label undergo a thorough antibiotic allergy assessment. These labels should be removed if the patient did not have a true immune-mediated reaction. An assessment of the severity, timing and tolerance of allergic reactions will lead to more de-labelling and improved prescribing. […] In patients with a low risk of severe allergic reactions, cephalosporins can be considered as an appropriate treatment option to penicillins.

• #21 Penicillin – Wikipedia

  https://en.wikipedia.org/wiki/Penicillin

  Ten percent of the population claims penicillin allergies, but because the frequency of positive skin test results decreases by 10% with each year of avoidance, 90% of these patients can eventually tolerate penicillin. […] Additionally, those with penicillin allergies can usually tolerate cephalosporins (another group of -lactam) because the immunoglobulin E (IgE) cross-reactivity is only 3%. […] Common (1% of people) adverse drug reactions associated with use of the penicillins include diarrhoea, hypersensitivity, nausea, rash, neurotoxicity, urticaria, and superinfection (including candidiasis). […] Penicillin can also induce serum sickness or a serum sickness-like reaction in some individuals. […] Allergy will occur in 110% of people, presenting as a skin rash after exposure. IgE-mediated anaphylaxis will occur in approximately 0.01% of patients.

• #22 Penicillin Allergy

  https://www.medscape.com/viewarticle/487541

  Whenever a patient reports a history of drug allergy, the healthcare provider must be vigilant in determining whether the reported reaction was truly an allergic reaction, and if so, must safeguard the patient against administration of drugs in the same drug class or structurally similar drug classes, for fear of cross-reactivity. […] Thus, the Septra prescription would have been safe to administer to the patient with documented penicillin allergy. […] It is true that there is a cross-reactivity between penicillins and cephalosporins of 3% to 5%, and thus, in the documented „anaphylactic” penicillin-allergic patient (such as yours), cephalosporins could not be safely recommended, and an alternative from another drug class (eg, macrolide, quinolone) would be warranted.

• #23

  https://www.nhstaysideadtc.scot.nhs.uk/Antibiotic%20site/penhypers.htm

  Patients with a history of Type I allergy clinically recognisable by features of urticaria, laryngeal oedema, bronchospasm, hypotension or local swelling within 72 hours of administration, or development of a pruritic rash (even after 72 hours) should NOT receive a penicillin. […] Patients with no evidence of Type I allergy to penicillin may be treated with any cephalosporin or beta lactam antibiotic for infections of any severity. […] Patients with symptoms suggestive of a Type I allergy should avoid cephalosporins and other beta-lactam antibiotics for mild or moderate infections when a suitable alternative exists. In life threatening infections, when use of a non-cephalosporin antibiotic would be sub-optimal, consider giving, under observation, a second or third generation cephalosporin (e.g. cefuroxime, ceftriaxone, ceftazidime).

• #24 Penicillin allergy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/diagnosis-treatment/drc-20376226

  If there are no other suitable antibiotic treatment options available, your doctor may recommend a treatment called drug desensitization that may enable you to take a course of penicillin to treat an infection. […] If you can reach the desired dosage with no reaction, then you can continue the treatment. […] It’s important to take the drug as directed to maintain your tolerance to it during the entire course of treatment. […] Desensitization is not always successful, and there is a risk of serious reactions.

• #25 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication. […] For persons who have a positive skin test reactive to penicillin (either to the major or minor determinants), treatment with a -lactam antibiotic is not usually advised, and other effective antimicrobials should be used. […] Desensitization is required for persons who have a documented penicillin allergy and for whom no therapeutic alternatives exist (e.g., syphilis during pregnancy and persons with neurosyphilis). […] Patients who have a positive skin test should not receive -lactam drugs in the ambulatory setting and should be referred to an allergist or penicillin allergy expert for further evaluation. […] If treatment with penicillin or ceftriaxone is indicated, it can be administered safely.

• #26 Patient education: Allergy to penicillin and related antibiotics (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/allergy-to-penicillin-and-related-antibiotics-beyond-the-basics/print

  People who have frequent infections and have suspected allergies to many antibiotics, leaving few options for treatment […] People who are immune compromised and therefore more likely to develop infections and need antibiotics […] Desensitization can be done for people who are truly allergic to penicillin but require treatment with it or a closely related antibiotic. Desensitization refers to a process of giving a medication in a controlled and gradual manner, which allows the person to tolerate it temporarily without an allergic reaction. […] Desensitization is temporary. A person is unlikely to have an allergic reaction to the medication during treatment, after undergoing desensitization, as long as the antibiotic is taken regularly. However, once the antibiotic is stopped for more than 24 hours, the person is again at risk for a sudden allergic reaction. Repeat desensitization is required if the same medication is needed again.

• #27 Patient education: Allergy to penicillin and related antibiotics (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/allergy-to-penicillin-and-related-antibiotics-beyond-the-basics/print

  People who have frequent infections and have suspected allergies to many antibiotics, leaving few options for treatment […] People who are immune compromised and therefore more likely to develop infections and need antibiotics […] Desensitization can be done for people who are truly allergic to penicillin but require treatment with it or a closely related antibiotic. Desensitization refers to a process of giving a medication in a controlled and gradual manner, which allows the person to tolerate it temporarily without an allergic reaction. […] Desensitization is temporary. A person is unlikely to have an allergic reaction to the medication during treatment, after undergoing desensitization, as long as the antibiotic is taken regularly. However, once the antibiotic is stopped for more than 24 hours, the person is again at risk for a sudden allergic reaction. Repeat desensitization is required if the same medication is needed again.

• #28 Penicillin Allergy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26892

  For those patients presenting with mild reactions and have cutaneous findings only, treatment with an antihistamine such as diphenhydramine is adequate. […] For patients with a true Type 1 IgE mediated penicillin allergy, another antibiotic should be used for treatment. If there is not another equally as efficacious antibiotic, patient’s should undergo drug desensitization. The process of desensitization involves subcutaneous, intravenous, or oral administration of incrementally higher doses of the drug every 15 to 30 minutes until the patient tolerates the entire dose. For patients with histories of severe IgE mediated reactions, initial doses should be between 1/1,000,000 and 1/10,000 of the full therapeutic dose. Success rates for desensitization can reach up to 100%. Drug desensitization is again contraindicated in patients with severe non-IgE-mediated reactions such as SJS or TEN.

• #29 Penicillin Allergy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26892

  For those patients presenting with mild reactions and have cutaneous findings only, treatment with an antihistamine such as diphenhydramine is adequate. […] For patients with a true Type 1 IgE mediated penicillin allergy, another antibiotic should be used for treatment. If there is not another equally as efficacious antibiotic, patient’s should undergo drug desensitization. The process of desensitization involves subcutaneous, intravenous, or oral administration of incrementally higher doses of the drug every 15 to 30 minutes until the patient tolerates the entire dose. For patients with histories of severe IgE mediated reactions, initial doses should be between 1/1,000,000 and 1/10,000 of the full therapeutic dose. Success rates for desensitization can reach up to 100%. Drug desensitization is again contraindicated in patients with severe non-IgE-mediated reactions such as SJS or TEN.

• #30 Penicillin Allergy FAQ

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/penicillin-allergy-faq

  The typical process of desensitization has excellent success for patients who have experienced immediate reactions to penicillin and involves introduction of very tiny doses of the penicillin drug either orally or intravenously every 15-20 minutes over a period of 4 hours or so. […] However the procedure is only temporary and once treatment has finished, a repeat desensitization would be required if the antibiotic is needed again in the future. […] It is generally recommended that you avoid all drugs in the immediate penicillin family (amoxicillin, ampicillin, amoxicillin-clavulanate, dicloxacillin, nafcillin, piperacillin-tazobactam as well as certain drugs in the cephalosporin class (a closely related class to penicillins). […] The decision of whether you need to carry epinephrine should be made after specialty consultation with your allergist / immunologist. In general, it is not recommended that patients who have a history of penicillin allergy carry epinephrine.

• #31 Penicillin Allergy > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/penicillin-allergy

  Treatment includes an alternative antibiotic or a process of desensitization to penicillin. […] If a patient tests positive for a penicillin allergy, the doctor will need to prescribe another antibiotic in place of penicillin. If penicillin is needed to treat an infection, a drug desensitization treatment will be used. […] The desensitization protocol is a procedure we do to induce temporary immune tolerance to the penicillin or a penicillin derivative, says Dr. Zheng. […] Desensitization involves starting medication at miniscule doses and increasing the rate of administration every 15 to 20 minutes. […] This allows the patient to complete the course of therapy with a particular antibiotic, Dr. Zheng says. […] While drug desensitization enables a patient to complete a course of treatment using penicillin, once the medication is discontinued, or if treatment is interrupted for about two days, the patients hypersensitivity to the medication returns. The patient may need to go through the same protocol again.

• #32 Patient education: Allergy to penicillin and related antibiotics (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/allergy-to-penicillin-and-related-antibiotics-beyond-the-basics/print

  People who have frequent infections and have suspected allergies to many antibiotics, leaving few options for treatment […] People who are immune compromised and therefore more likely to develop infections and need antibiotics […] Desensitization can be done for people who are truly allergic to penicillin but require treatment with it or a closely related antibiotic. Desensitization refers to a process of giving a medication in a controlled and gradual manner, which allows the person to tolerate it temporarily without an allergic reaction. […] Desensitization is temporary. A person is unlikely to have an allergic reaction to the medication during treatment, after undergoing desensitization, as long as the antibiotic is taken regularly. However, once the antibiotic is stopped for more than 24 hours, the person is again at risk for a sudden allergic reaction. Repeat desensitization is required if the same medication is needed again.

• #33 Penicillin Allergy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26892

  For those patients presenting with mild reactions and have cutaneous findings only, treatment with an antihistamine such as diphenhydramine is adequate. […] For patients with a true Type 1 IgE mediated penicillin allergy, another antibiotic should be used for treatment. If there is not another equally as efficacious antibiotic, patient’s should undergo drug desensitization. The process of desensitization involves subcutaneous, intravenous, or oral administration of incrementally higher doses of the drug every 15 to 30 minutes until the patient tolerates the entire dose. For patients with histories of severe IgE mediated reactions, initial doses should be between 1/1,000,000 and 1/10,000 of the full therapeutic dose. Success rates for desensitization can reach up to 100%. Drug desensitization is again contraindicated in patients with severe non-IgE-mediated reactions such as SJS or TEN.

• #34 Penicillin Allergy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26892

  For those patients presenting with mild reactions and have cutaneous findings only, treatment with an antihistamine such as diphenhydramine is adequate. […] For patients with a true Type 1 IgE mediated penicillin allergy, another antibiotic should be used for treatment. If there is not another equally as efficacious antibiotic, patient’s should undergo drug desensitization. The process of desensitization involves subcutaneous, intravenous, or oral administration of incrementally higher doses of the drug every 15 to 30 minutes until the patient tolerates the entire dose. For patients with histories of severe IgE mediated reactions, initial doses should be between 1/1,000,000 and 1/10,000 of the full therapeutic dose. Success rates for desensitization can reach up to 100%. Drug desensitization is again contraindicated in patients with severe non-IgE-mediated reactions such as SJS or TEN.

• #35 PCN allergy — The Center for Allergy & Immunology

  https://www.kcallergycenter.com/pcn-allergy

  Nearly everyone knows someone who says they are allergic to penicillin. Up to 10 percent of people report being allergic to this widely used class of antibiotic, making it the most commonly reported drug allergy. Over time, however, the vast majority of people who once had a severe allergic reaction to penicillin lose sensitivity and can be treated safely with the drug (although 10 percent of individuals will remain allergic). […] Understanding penicillin allergies is important for a variety of reasons. For certain conditions, penicillin is the best (or only proven) therapy. […] A less common but more serious, sudden-onset allergic reaction to penicillin is anaphylaxis, which occurs in highly sensitive patients. […] These symptoms require immediate attention at the nearest Emergency Room. Epinephrine, the therapy of choice, will be given in this urgent care setting, but should also be self-administered via autoinjector as soon as possible by patients who have already been prescribed and are wisely carrying this device.

• #36 Penicillin Allergy Delabeling in Syphilis Patients Assists in Furthering Treatment – ACAAI Patient

  https://acaai.org/news/penicillin-allergy-delabeling-in-syphilis-patients-assists-in-furthering-treatment/

  Penicillin Allergy Delabeling in Syphilis Patients Assists in Furthering Treatment […] Study shows syphilis patients can safely have penicillin allergy label removed […] A new study being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Boston showed that syphilis patients labeled as penicillin allergic who are low risk should be delabeled to avoid treatment failure and other negative health consequences. […] The authors conclude that most patients labeled as penicillin allergic should have their allergies evaluated as quickly as possible after a syphilis diagnosis and should be aggressively delabeled to avoid treatment failure, increased healthcare utilization, and negative public health consequences. […] We have shown that most patients labeled as penicillin allergic that are low risk should be aggressively delabeled to avoid treatment failure, increased healthcare utilization, and negative public health consequences.

• #37 Penicillin Allergy Delabeling in Syphilis Patients Assists in Furthering Treatment – ACAAI Patient

  https://acaai.org/news/penicillin-allergy-delabeling-in-syphilis-patients-assists-in-furthering-treatment/

  Penicillin Allergy Delabeling in Syphilis Patients Assists in Furthering Treatment […] Study shows syphilis patients can safely have penicillin allergy label removed […] A new study being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Boston showed that syphilis patients labeled as penicillin allergic who are low risk should be delabeled to avoid treatment failure and other negative health consequences. […] The authors conclude that most patients labeled as penicillin allergic should have their allergies evaluated as quickly as possible after a syphilis diagnosis and should be aggressively delabeled to avoid treatment failure, increased healthcare utilization, and negative public health consequences. […] We have shown that most patients labeled as penicillin allergic that are low risk should be aggressively delabeled to avoid treatment failure, increased healthcare utilization, and negative public health consequences.

• #38 Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy

  https://www.mdpi.com/2079-6382/12/4/737

  Treatment of H. pylori infection has faced many challenges due to increasing antibiotic resistance. Resistance rates for clarithromycin range from 17% to 31.5%, levofloxacin from 15.8% to 37.6%, and metronidazole from 38.9% to 44%, with variations depending on the geographic region. However, amoxicillin had a low resistance rate of less than 3% to 5% in most countries. Amoxicillin is an essential component of the regimen for the eradication of H. pylori due to its low resistance rate, safety, affordability, and availability. It is important to note that 5% to 15% of patients in developed countries have reported a penicillin allergy, with rates of 9.3% in South Australia and 10% in the US. Both the American College of Gastroenterology (ACG) guideline and the Toronto Consensus recommend bismuth quadruple therapy as a treatment for patients with penicillin allergy. Similarly, the Maastricht VI/Florence consensus report also suggested that bismuth quadruple therapy was the preferred treatment option for this population. Recent studies have shown that the vonoprazan-based regimen was at least as effective as the PPI-based regimen. In addition, several studies have reported promising results with vonoprazan containing antibiotic regimen in patients with penicillin allergy. The objective of this review is to report the efficacy, safety, and adherence of various treatments available for H. pylori infection in patients with confirmed penicillin allergy, based on evidence gathered from clinical trials and real-world observational studies.

• #39 Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy

  https://www.mdpi.com/2079-6382/12/4/737

  Treatment of H. pylori infection has faced many challenges due to increasing antibiotic resistance. Resistance rates for clarithromycin range from 17% to 31.5%, levofloxacin from 15.8% to 37.6%, and metronidazole from 38.9% to 44%, with variations depending on the geographic region. However, amoxicillin had a low resistance rate of less than 3% to 5% in most countries. Amoxicillin is an essential component of the regimen for the eradication of H. pylori due to its low resistance rate, safety, affordability, and availability. It is important to note that 5% to 15% of patients in developed countries have reported a penicillin allergy, with rates of 9.3% in South Australia and 10% in the US. Both the American College of Gastroenterology (ACG) guideline and the Toronto Consensus recommend bismuth quadruple therapy as a treatment for patients with penicillin allergy. Similarly, the Maastricht VI/Florence consensus report also suggested that bismuth quadruple therapy was the preferred treatment option for this population. Recent studies have shown that the vonoprazan-based regimen was at least as effective as the PPI-based regimen. In addition, several studies have reported promising results with vonoprazan containing antibiotic regimen in patients with penicillin allergy. The objective of this review is to report the efficacy, safety, and adherence of various treatments available for H. pylori infection in patients with confirmed penicillin allergy, based on evidence gathered from clinical trials and real-world observational studies.

• #40 Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy

  https://www.mdpi.com/2079-6382/12/4/737

  First-line therapy: Sue et al. found the combination therapy of vonoprazan, clarithromycin, and metronidazole (VC1M1) for 7 days achieved an eradication rate of 100% in a prospective study. Similarly, Ono et al. reported a high eradication rate of 92.3% for 7-day VC1M1 therapy. This finding suggests that VC1M1 may be effective in patients who have failed other treatments, although further research is needed to confirm the efficacy of this regimen under this situation. In a retrospective study, a 7-day course of VC1M1 was used to treat patients who had penicillin allergy with or without previous therapies. This combination achieved a high eradication rate of 94.3%. Additionally, in patients with clarithromycin-resistant infection, the eradication rate was 90.9%. These findings suggest that vonoprazan-based therapy is an effective treatment for H. pylori infection in patients with penicillin allergy, including those with clarithromycin-resistant infections.

• #41 Predicting True Penicillin Allergy in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0615/p760.html

  A more recent study derived and validated a clinical prediction rule for penicillin allergy. The PEN-FAST (penicillin allergy, five or fewer years ago, anaphylaxis/angioedema, severe, treatment) rule was derived from a prospective cohort of 622 allergy-tested patients in Melbourne, Australia, using a multivariable logistic regression model. This identified five independent predictors of an oral challenge positive for penicillin allergy. […] The study identified three risk factors to include in the clinical prediction rule: […] Allergy event occurring five or fewer years ago (2 points) […] Anaphylaxis/angioedema or severe cutaneous adverse reaction (2 points) […] Treatment required for the episode (1 point) […] Total scoring ranged from 0 to 5, allowing for stratification of patients based on risk of a positive result on penicillin allergy testing. The investigators chose a cutoff score of less than 3 points, which yielded a sensitivity of 70.7% and specificity of 78.5% in the derivation cohort.

• #42 PEN-FAST Forward: Accelerating Penicillin Allergy De-Labeling

  https://www.contagionlive.com/view/pen-fast-forward-accelerating-penicillin-allergy-de-labeling

  PEN-FAST is a validated risk stratification tool that promotes efficient, safe, and effective de-labeling of penicillin allergies. […] De-labeling previous penicillin allergies can aid in improving patient outcomes, as well as improve stewardship efforts. […] Allergy History The American Academy of Allergy, Asthma, and Immunology (AAAAI) endorses proactive penicillin allergy de-labeling efforts. […] In patients who have reactions that are more consistent with intolerance than allergy, AAAAI recommends the removal of a penicillin allergy label without any additional testing. […] The PEN-FAST score is an incredibly useful tool for determining appropriate de-labeling strategies. […] Among eligible patients that are low-risk (PEN-FAST score of 0-2), an oral amoxicillin challenge may be considered.

• #43 Predicting True Penicillin Allergy in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0615/p760.html

  The likelihood of a true allergy in those with a PEN-FAST score of less than 3 points is similar to that for a negative result on skin testing. Therefore, stratifying patients using the PEN-FAST rule may aid in decisions related to immediate antibiotic treatment and referral for allergy testing. Use of the PEN-FAST rule has the potential for significant downstream benefits of improved antibiotic prescribing over the course of the patient-clinician relationship and enhanced antimicrobial stewardship. […] Using the PEN-FAST rule, this patient has a score of 1, for requiring treatment for the potential reaction, and therefore has a low risk (about 5%) of a positive result on allergy testing. You discuss treatment options, the estimate of risk, and other potential benefits and harms with the patient and elicit the patient’s preferences. Through this, you make a shared decision to prescribe amoxicillin, and you provide the patient with information on warning signs for allergic reaction and actions to take if this occurs.

• #44 PEN-FAST Forward: Accelerating Penicillin Allergy De-Labeling

  https://www.contagionlive.com/view/pen-fast-forward-accelerating-penicillin-allergy-de-labeling

  If the patient tolerates the dose without a reaction during the monitoring period, the allergy can safely be removed from the patients chart and their reaction history should no longer prevent them from receiving penicillins in the future. […] While de-labeling has traditionally been done with a penicillin skin test followed by an oral challenge, the PALACE trial demonstrated that a direct oral challenge in patients with a PEN-FAST score of 0-2 was equally safe to performing skin testing followed by an oral challenge. […] Collecting an accurate allergy history and evaluating true allergy risk can help health care professionals identify and remove unnecessary penicillin allergy labels.

• #45 Penicillin | healthdirect

  https://www.healthdirect.gov.au/penicillin

  If you are diagnosed with an allergy to penicillin, you will need to avoid it in future. Always tell medical staff about the allergy. Make sure it is recorded on your My Health Record, in your doctor’s medical records and in any hospital records. You should also wear a medical alert bracelet. […] There are other types of antibiotics that you can take if you are allergic to penicillin or if penicillin isn’t available. Ask your doctor which other medicines would be appropriate for your condition.

• #46

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abn3536

  The first thing to do to treat a penicillin allergy is stop taking the medicine. A mild reaction often can be treated with over-the-counter antihistamines. These medicines stop swelling and itching. Some people may need prescription medicine. For a severe reaction, you may need a shot of epinephrine or other medicines. […] Avoid penicillin and medicines like it. Be sure that anyone treating you for any health problem knows what medicines you are allergic to. Take medicines for the allergic reaction as directed. If you are at risk for a severe allergic reaction, always have an epinephrine shot with you. Make sure it has not expired. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #47 Penicillin Allergy – Australasian Society of Clinical Immunology and Allergy (ASCIA)

  https://www.allergy.org.au/patients/drug-allergy/penicillin

  If allergy testing shows that you do not have a penicillin allergy, you can be prescribed penicillin or related antibiotics in the future, to ensure effective and efficient treatment of bacterial infections. […] If a true penicillin allergy is diagnosed after testing: Your doctor will advise you to avoid the penicillin you have tested positive to. A drug allergy specialist will tell you if you are able to safely take other types of penicillin. If you are allergic to all penicillins, other antibiotics will be prescribed for bacterial infections. Your allergy should be recorded in hospital, doctor, and pharmacy records and uploaded to your My Health Record. You may also be advised to carry medical identification of your allergy. Your doctor may provide you with an ASCIA Action Plan for Drug (Medication) Allergy.

• #48 Penicillin allergy

  https://eastkentformulary.nhs.uk/therapeutic-sections/5-infection/antimicrobial-guide-primary-care/supporting-information-antimicrobials/penicillin-allergy/

  Any patient describing anaphylaxis following penicillin exposure must not be prescribed any penicillin again, nor any cephalosporin. […] Patients with a history of immediate hypersensitivity following administration of penicillin, recognisable by features of urticaria, laryngeal oedema, bronchospasm, hypotension or local swelling within 72 hours of administration, should not receive a penicillin. […] Patients who are truely allergic to one penicillin will be allergic to all because the hypersensitivity is related to the basic penicillin structure. […] Patients with a definite history of non-urticarial rash allergy to penicillin should not receive a penicillin but the likelihood of serious cross-sensitivity with cephalosporins or carbapenems is very low so other non-penicillin beta lactam antibiotics can be used in these patients.

• #49 Penicillin allergy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/symptoms-causes/syc-20376222

  Penicillin allergy is an abnormal reaction of your immune system to the antibiotic drug penicillin. […] Therefore, an accurate diagnosis is needed when penicillin allergy is suspected to ensure the best treatment options in the future. […] See your doctor as soon as possible if you experience signs or symptoms of penicillin allergy. It’s important to understand and discuss what is an allergic reaction, what is a typical side effect and what you can tolerate in taking a medication. […] Call 911 or emergency medical help if you experience signs of a severe reaction or suspected anaphylaxis after taking penicillin.

• #50 Penicillin | healthdirect

  https://www.healthdirect.gov.au/penicillin

  If someone takes penicillin and has trouble breathing, swelling of the face, throat or tongue, wheeze or cough, difficulty talking, dizziness or collapse, it could be anaphylaxis. If the person carries an EpiPen or Anapen auto-injector, use it. Call triple zero (000) and ask for an ambulance. If they are unresponsive and not breathing, start CPR. […] About 1 in 100 people has an allergy to penicillin, and about 1 in 3,000 people has a life-threatening allergic reaction to penicillin. If you are allergic to one type of penicillin, you will also likely be allergic to other types too. Always ask your doctor if you are not sure about your allergies. […] If you have serious trouble breathing (heavy wheezing) or if your face starts swelling, you might have penicillin anaphylaxis. […] Your doctor might refer you for tests to confirm your allergy. Tell your doctor, dentist and all other health providers if you have ever had any symptoms of penicillin allergy.

• #51 Penicillin Allergy – Causes, symptoms and Treatment | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/penicillin-allergy-causes-symptoms-and-treatment

  Penicillin allergies lead to symptoms such as skin rashes and extreme itching and can even cause anaphylaxis which is life threatening. Patients should be aware of their penicillin allergy and inform their doctor while they prescribe medications against infections. […] If you experience any of these symptoms, emergency care immediately. […] Depending on the severity of the symptoms of penicillin allergy, your doctor may recommend one of the following treatment modalities: For minor allergic reactions, your doctor may prescribe antihistamines (eg. diphenhydramine) to alleviate the symptoms. For severe allergic reactions, the doctor may recommend corticosteroid-based medications. For penicillin allergies that trigger anaphylaxis, EpiPen or epinephrine drug may be administered to you. This will block the allergic reaction from spreading, increasing the blood pressure. Drug desensitization through consumption of increasing dosage of penicillin under medical guidance can also help against penicillin allergies. […] It is necessary to take due precautions against penicillin allergies. The risk of severe symptoms, hypersensitivity reactions, anaphylaxis and other disorders are detrimental to the health of a patient.

• #52 Penicillin | healthdirect

  https://www.healthdirect.gov.au/penicillin

  If someone takes penicillin and has trouble breathing, swelling of the face, throat or tongue, wheeze or cough, difficulty talking, dizziness or collapse, it could be anaphylaxis. If the person carries an EpiPen or Anapen auto-injector, use it. Call triple zero (000) and ask for an ambulance. If they are unresponsive and not breathing, start CPR. […] About 1 in 100 people has an allergy to penicillin, and about 1 in 3,000 people has a life-threatening allergic reaction to penicillin. If you are allergic to one type of penicillin, you will also likely be allergic to other types too. Always ask your doctor if you are not sure about your allergies. […] If you have serious trouble breathing (heavy wheezing) or if your face starts swelling, you might have penicillin anaphylaxis. […] Your doctor might refer you for tests to confirm your allergy. Tell your doctor, dentist and all other health providers if you have ever had any symptoms of penicillin allergy.

• #53 The Truth About Penicillin Allergy … And Why it’s Important to Get Tested – Allergy & Asthma Network

  https://allergyasthmanetwork.org/news/the-truth-about-penicillin-allergy-and-why-its-important-to-get-tested/

  Here’s perhaps the best part of undergoing a penicillin allergy test: you get the results the same day. The process takes about 2 to 3 hours, including the time needed for doctors to monitor you for a reaction. […] If it’s confirmed you or your child are not allergic to penicillin, there’s still one more step: remove the allergic to penicillin label on medical records.

• #54 Do you really have a penicillin allergy? – Harvard Health

  https://www.health.harvard.edu/blog/do-you-really-have-a-penicillin-allergy-2019022616017

  An allergist can assist in the diagnosis of a penicillin allergy using a skin test. […] People who have no reaction to the skin test can safely undergo the amoxicillin challenge. […] The best time to have a penicillin allergy evaluated is when you’re healthy. […] Clarifying medication allergies is also a good idea before an operation; a penicillin allergy can impact infection risk. […] Pregnant patients can also be evaluated safely for a penicillin allergy in their third trimester.

• #55 Do you really have a penicillin allergy? – Harvard Health

  https://www.health.harvard.edu/blog/do-you-really-have-a-penicillin-allergy-2019022616017

  An allergist can assist in the diagnosis of a penicillin allergy using a skin test. […] People who have no reaction to the skin test can safely undergo the amoxicillin challenge. […] The best time to have a penicillin allergy evaluated is when you’re healthy. […] Clarifying medication allergies is also a good idea before an operation; a penicillin allergy can impact infection risk. […] Pregnant patients can also be evaluated safely for a penicillin allergy in their third trimester.

• #56 Penicillin allergies: What parents need to know | Children’s Mercy Kansas City

  https://www.childrensmercy.org/parent-ish/2024/03/penicillin-allergies/

  After gathering this information, or if your child’s prior reaction is unknown, your healthcare provider may refer your child to a specialist for further evaluation/testing to see whether your child can be treated with a penicillin antibiotic again in the future or not. […] Antibiotic allergy testing is done at Childrens Mercy Kansas City’s Infectious Disease Antibiotic Challenge Clinic (for allergy testing to penicillin and amoxicillin only) and at Childrens Mercy Allergy Clinic for these and other antibiotics. […] If your child previously had a serious reaction to a penicillin or if the specialist has concerns related to the type of reaction, your child may have a skin test followed by the oral antibiotic. […] If your child does not react during the visit, they are unlikely to have a serious immediate reaction when they receive this antibiotic in the future.

• #57 GGC Medicines: Penicillin Allergy

  https://ggcmedicines.org.uk/blog/medicines-update/penicillin-allergy/

  Over-reporting of penicillin allergy leads to unnecessary use of broad-spectrum/less effective alternatives which increases costs, resistance and adverse outcomes such as increased rates of clostridium difficile (CDI), staphylococcus aureus bacteraemia (SAB), longer hospital stays and surgical site infections. […] It is important to differentiate between true penicillin allergy and intolerance/side effects. A limited penicillin allergy de-labelling service for in-patients is available at QEUH (contact the ID registrar on-call). For further information on de-labelling, refer to Scottish Antimicrobial Prescribing Group (SAPG) website. […] True penicillin allergy includes Type I reactions (e.g. anaphylaxis, urticaria or rash immediately after penicillin administration) AND Type 4 reactions (e.g. Stevens-Johnson syndrome, DRESS). In cases of intolerance to penicillin (e.g. GI upset) or a minor rash/rash occurring 72 hours after administration, penicillins/related antibiotics should not be withheld unnecessarily in severe infection but the patient must be monitored closely after administration. […] In true penicillin allergy avoid all penicillins, cephalosporins and other beta-lactam antibiotics (see image below). […] Communicate and document any changes to allergy status across care sectors. […] Refer to NHSGGC Penicillin Allergy (Adult) guideline for further information.

• #58 Penicillin allergy—getting the label right | The BMJ

  https://www.bmj.com/content/358/bmj.j3402

  Penicillin allergy is a potentially serious adverse reaction that alters and reduces the options for antibacterial treatment, and which can be life threatening. It is the most commonly noted drug allergy in the UK, reported by about 10% of the population. It is estimated, however, that only around 20% of those reporting penicillin allergy are truly allergic. It is important that the term penicillin allergy is correctly applied to avoid adverse effects or inappropriate treatment. […] The diagnostic workup for penicillin allergy includes clinical history, skin tests, in vitro testing, and drug provocation tests. […] Some cephalosporins with a different side chain to the reacting penicillin can be considered under specialist management for life threatening infections when non-cephalosporin antibacterial drugs would be suboptimal.

• #59 Penicillin Allergy: Symptoms, Tests, Treatment and Desensitization

  https://www.webmd.com/allergies/penicillin-allergy

  If you have taken penicillin without realizing you have an allergy, stop taking it and call your doctor. […] They may prescribe a medicine called an antihistamine, such as diphenhydramine, to help with your symptoms. For more serious problems such as swelling, they might give you a medicine called a corticosteroid. […] If you have anaphylaxis, theyll give you a drug called epinephrine right away. Youll spend some time in the hospital until your blood pressure and breathing are better. […] If you really need penicillin, you may get a treatment called desensitization. You usually would get this only if you didnt react with anaphylaxis previously. […] In desensitization, your doctor will start you with a small dose of penicillin. If you dont show allergy symptoms in 15-30 minutes, then you get a higher dose. […] You get higher doses over a few hours or days. If you dont have symptoms, then you can keep taking penicillin.

• #60 Penicillin allergy: a practical approach to assessment and prescribing

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6954877/

  If there was a delayed, non-severe reaction (such as mild childhood rashes or a maculopapular rash that occurred over 10 years ago) an oral rechallenge with low-dose penicillin can be considered. […] While penicillin allergies can be life-threatening, it is important to ensure that all patients with a recorded penicillin allergy label undergo a thorough antibiotic allergy assessment. These labels should be removed if the patient did not have a true immune-mediated reaction. An assessment of the severity, timing and tolerance of allergic reactions will lead to more de-labelling and improved prescribing. […] In patients with a low risk of severe allergic reactions, cephalosporins can be considered as an appropriate treatment option to penicillins.

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