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Penicillin allergy: Immediate reactions

Author
Roland Solensky, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD

INTRODUCTION

Penicillin allergy is the most commonly reported medication allergy. Five to 10 percent of patients report some type of penicillin allergy [1-3]. Upon thorough evaluation, many of these patients are found not to be allergic and are able to safely receive penicillin. However, penicillins are among the leading causes of drug-induced anaphylaxis, including fatalities. Thus, a systematic approach to the evaluation of penicillin allergy is necessary.

This topic reviews immediate allergic reactions to penicillins, which are most often defined as reactions that develop within minutes to one hour of administration. The epidemiology, risk factors, diagnosis, and management of immediate reactions to penicillins will be discussed here. The procedure for skin testing to penicillins and the use of structurally-related antibiotics in patients with past reactions to penicillins are reviewed separately. Delayed forms of penicillin hypersensitivity are also discussed separately. (See "Penicillin skin testing" and "Penicillin-allergic patients: Use of cephalosporins, carbapenems, and monobactams" and "Penicillin allergy: Delayed hypersensitivity reactions".)

DEFINITION

An allergic drug reaction is defined as a specific immunologic reaction to a drug [4]. The classification and pathogenesis of drug allergies are discussed in detail separately. (See "Drug allergy: Classification and clinical features" and "Drug allergy: Pathogenesis".)

Immediate versus delayed reactions — The World Allergy Organization (WAO) has recommended categorizing immunologic drug reactions based upon the timing of the appearance of symptoms [4]. This system defines two broad categories of reactions: immediate and delayed. This approach is intended to distinguish immunoglobulin E (IgE)-mediated (type I reactions), which account for many immediate reactions, from other types, because IgE-mediated reactions carry the risk of life-threatening anaphylaxis if the patient is reexposed.

Immediate reactions classically begin within one hour of the last administered dose and may begin within minutes. However, some immediate reactions appear after one hour, particularly if the drug was administered orally or taken with food. For these reasons, some guidelines include reactions beginning up to six hours after the last administered dose in the immediate category [5]. Nevertheless, the period of one hour identifies most immediate reactions. When allergic sensitization first develops, the initial symptoms may appear during the latter days of treatment (ie, not following the first dose of the course), but usually within an hour of the last administered dose, and then escalate rapidly with any successive doses.

                                     

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Literature review current through: Nov 2016. | This topic last updated: Thu Jul 07 00:00:00 GMT+00:00 2016.
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