- 1.Read the activity.
- 2.Complete the online CME Test and Evaluation. Participants must achieve a score of 80% on the CME Test. One retake is allowed.
Core Elements of Hospital Antibiotic Stewardship Programs.
Classifications and Clinical Manifestations of Penicillin Allergy
Applicability of Clinical History When Evaluating Penicillin Allergy
- •What were the signs and symptoms of the adverse drug reaction and when did they occur? Signs and symptoms consistent with IgE-mediated reactions may corroborate that an allergic reaction had occurred. Symptoms that are more likely non-IgE mediated, such as dyspepsia, diarrhea, or headache, may raise the question whether a previous reaction should have been attributed to penicillin allergy. Penicillin allergy tends to wane over time, so individuals experiencing reactions years ago may have a greater likelihood of being nonallergic.
- •What was the time course of the adverse drug reaction? Symptoms occurring either during or immediately after a treatment course would be consistent with an IgE-mediated allergic reaction. Delayed-onset reactions occurring well after a treatment course is completed would be expected to have negative penicillin allergy skin testing results.
- •Were other medications used concurrently at the time of the adverse drug reaction? Although penicillin and other antibiotics are frequent causes of drug reactions, other medications such as nonsteroidal anti-inflammatory drugs or opiates may cause similar symptoms.
- •Had the same or a similar medication been used before the reported adverse drug reaction? Classically, IgE-mediated drug allergic reactions require previous exposures during which allergic sensitization occurs. After this period of sensitization, reexposure to the drug may elicit an allergic reaction.
- •Has the same or a similar medication been used since the previous adverse drug reaction? If individuals have tolerated the reintroduction of penicillin or a related antibiotic, their allergy may have waned over time. Repeated reactions to the same or similar medications suggest ongoing allergy.
- •Why was penicillin or a related antibiotic prescribed? Signs and symptoms that were attributed to an adverse drug reaction may have been due to the underlying condition being treated. For example, streptococcal pharyngitis may cause a rash unto itself, no matter that penicillin was used as therapy.
- •Have symptoms similar to the adverse drug reaction occurred in the absence of medication therapy? In some instances, chronic idiopathic urticaria may mimic aspects of drug allergic reactions.
- •Has the medical record been reviewed for documentation of penicillin allergy and antibiotic use? Individuals may not recall specific details of their previous reactions or whether penicillin was actually the antibiotic used with previous reactions. They may also not realize that penicillin or a related antibiotic has been used since their initial reaction.
|• What were the signs, symptoms, and timing of the adverse drug reaction?|
|• Were other medications used concurrently at the time of the adverse drug reaction?|
|• Had the same or a similar medication been used before the reported adverse drug reaction?|
|• Has the same or a similar medication been used since the previous adverse drug reaction?|
|• Why was penicillin or a related antibiotic prescribed?|
|• Have symptoms similar to the adverse drug reaction occurred in the absence of medication therapy?|
|• Has the medical record been reviewed for documentation of penicillin allergy and antibiotic use?|
Penicillin Allergy Testing
- Green G.R.
- Rosenblum A.H.
- Sweet L.C.
Management of Penicillin Allergy
Cross-Reactivity Issues With Penicillin Allergy (Cephalosporins, Carbapenems, Monobactams)
Supplemental Online Material
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- Clinical and genetic risk factors of self-reported penicillin allergy.J Allergy Clin Immunol. 2008; 122: 152-158
- Drug allergy: an updated practice parameter.Ann Allergy Asthma Immunol. 2010; 105: 259-273
- U.S. outpatient antibiotic prescribing, 2010.N Engl J Med. 2013; 368: 1461-1462
- Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data.Lancet Infect Dis. 2014; 14: 742-750
- The economic burden of antibiotic treatment of penicillin-allergic patients in internal medicine wards of a general tertiary care hospital.Clin Exp Allergy. 2003; 33: 501-506
- Treatment of patients with a history of penicillin allergy in a large tertiary-care academic hospital.J Allergy Clin Immunol Pract. 2013; 1: 252-257
- A real time prospective evaluation of clinical pharmaco-economic impact of diagnostic label of ‘penicillin allergy’ in a UK teaching hospital.J Clin Pathol. 2014; 67: 1088-1092
- Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study.J Allergy Clin Immunol. 2014; 133: 790-796
- The effect of penicillin allergy testing on future health care utilization: a matched cohort study.J Allergy Clin Immunol Pract. 2017; 5: 705-710
- Core Elements of Hospital Antibiotic Stewardship Programs.Center for Disease Control and Prevention, US Dept of Health and Human Services, Atlanta, GA2014Accessed September 18, 2017.)
- International Drug Monitoring: The Role of the Hospital.World Health Organization, Geneva1969 (Technical Report Series No. 425)
- International consensus on drug allergy.Allergy. 2014; 69: 420-437
- Drug allergy.J Allergy Clin Immunol. 2010; 125: S126-S137
- Penicillin allergy: prevalence of vague history in skin test-positive patients.Ann Allergy Asthma Immunol. 2000; 85: 195-199
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- Penicillin allergy: clinical experience with a battery of skin-test reagents.J Allergy Clin Immunol. 1982; 69: 238-244
- Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults.Arch Intern Med. 1992; 152: 1025-1032
- Clinical experience with penicillin skin testing in a large inner-city STD clinic.JAMA. 1993; 270: 2456-2463
- Evaluation of penicillin hypersensitivity: value of clinical history and skin testing with penicilloyl-polylysine and penicillin G. A cooperative prospective study of the penicillin study group of the American Academy of Allergy.J Allergy Clin Immunol. 1977; 60: 339-345
- Minor determinants are essential for optimal penicillin allergy testing: a pro/con debate.J Allergy Clin Immunol Pract. 2015; 3: 883-887
- Oral challenge without skin testing safely excludes clinically significant delayed-onset penicillin hypersensitivity.J Allergy Clin Immunol Pract. 2017; 5: 669-675
- Amoxicillin challenge without penicillin skin testing in evaluation of penicillin allergy in a cohort of Marine recruits.J Allergy Clin Immunol Pract. 2017; 5: 813-815
- The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge.J Allergy Clin Immunol. 2011; 127: 218-222
- Allergy to β-lactam antibiotics.J Allergy Clin Immunol. 2012; 130: 1442-1442.e5
- Penicillin and cephalosporin allergy.Ann Allergy Asthma Immunol. 2014; 112: 404-412
- IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of penicillins, monobactams, and carbapenems.J Allergy Clin Immunol. 2010; 126: 994-999
- Sensitization to aztreonam and cross-reactivity with other β-lactam antibiotics in high-risk patients with cystic fibrosis.J Allergy Clin Immunol. 1991; 87: 78-88
Potential Competing Interests: The authors report no competing interests.