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Penicillin allergy: Immediate reactions

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


Penicillin allergy is the most commonly reported medication allergy. Up to 10 percent of all patients and 15 percent of hospitalized 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. Related topics include the following:

An algorithmic approach to the use of related antibiotics, with and without access to penicillin skin testing, is presented separately. (See "Choice of antibiotics in penicillin-allergic hospitalized patients".)

Penicillin skin testing is described elsewhere. (See "Penicillin skin testing".)

Delayed reactions to penicillins, ranging from maculopapular drug eruptions to severe systemic reactions, are reviewed elsewhere. (See "Penicillin allergy: Delayed hypersensitivity reactions".)

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Literature review current through: Nov 2017. | This topic last updated: May 31, 2017.
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