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Penicillin allergy: optimizing diagnostic protocols, public health implications, and future research needs

Macy, Eric

Current Opinion in Allergy and Clinical Immunology: August 2015 - Volume 15 - Issue 4 - p 308–313
doi: 10.1097/ACI.0000000000000173
DRUG ALLERGY: Edited by Miguel Blanca and Bernard Y.-H. Thong

Purpose of review Unverified penicillin allergy is being increasingly recognized as a public health concern. The ideal protocol for verifying true clinically significant IgE-mediated penicillin allergy needs to use only commercially available materials, be well tolerated and easy to perform in both the inpatient and outpatient settings, and minimize false-positive determinations. This review concentrates on articles published in 2013 and 2014 that present new data relating to the diagnosis and management of penicillin allergy.

Recent findings Penicillin allergy can be safely evaluated at this time, in patients with an appropriate clinical history of penicillin allergy, using only penicilloyl-poly-lysine and native penicillin G as skin test reagents, if an oral challenge with amoxicillin 250 mg, followed by 1 h of observation, is given to all skin test negative individuals.

Summary Millions of individuals falsely labeled with penicillin allergy need to be evaluated to safely allow them to use penicillin-class antibiotics and avoid morbidity associated with penicillin avoidance. Further research is needed to determine optimal protocol(s). There will still be a 1–2% rate of adverse reactions reported with all future therapeutic penicillin-class antibiotic use, even with optimal methods used to determine acute penicillin tolerance. Only a small minority of these new reactions will be IgE-mediated.

Southern California Permanente Medical Group, Department of Allergy, San Diego Medical Center, San Diego, California, USA

Correspondence to Eric Macy, MD MS FAAAAI, Kaiser Permanente, Department of Allergy, 7060 Clairemont Mesa Blvd, San Diego, CA 92111, USA. Tel: +1 858 573 5410; fax: +1 858 573 5612; e-mail:

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