Penicillin allergy

Prevalence of vague history in skin test-positive patients

R. Solensky, H. S. Earl, R. S. Gruchalla

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Objective: Penicillin (PCN) skin testing is a reliable tool for predicting which patients can safely receive the antibiotic. Depending on the study, 7% to 76% of patients who have a history of PCN allergy have positive PCN skin tests. Many physicians approach patients who have a vague history of PCN allergy less cautiously than they approach those who have a convincing history suggestive of an IgE-mediated reaction. We reviewed the published literature to determine how many patients who had a history of PCN allergy and who were skin test-positive had a vague history of allergy. Data Sources: By cross-referencing the keywords "penicillin" and "skin test," an Ovid MEDLINE search for English language studies published from 1966 to 1998 was performed. Study Selection: Studies in which history positive/skin test-positive patients were identified, and which contained documentation of the type of previous reaction in these patients, were included in the analysis. The MEDLINE search revealed 295 English language articles, of which 27 fulfilled the inclusion criteria. Three additional studies published prior to 1966 (and therefore not available through MED-LINE) also were found, bringing the total to 30. A "convincing" history was defined to be one likely to be IgE-mediated (such as anaphylaxis, urticaria, angioedema or pruritic rash). A "vague" history was one unlikely to be IgE-mediated (such as maculopapular rash, G1 symptoms, or an unknown reaction). Results: Overall, 347/1063, or 33%, of history positive/skin test-positive patients had a vague PCN allergy history, with a range of 0% to 70% among the 30 studies. Conclusion: A large proportion of patients who have PCN-specific IgE antibodies, as determined by skin testing, have vague PCN allergy histories. These results therefore, indicate that, like patients with convincing histories, patients with vague allergic histories should undergo PCN skin testing prior to PCN administration. Ann Allergy Asthma Immunol 2000;85:195-199.

Original languageEnglish (US)
Pages (from-to)195-199
Number of pages5
JournalAnnals of Allergy, Asthma and Immunology
Volume85
Issue number3
StatePublished - 2000

Fingerprint

Skin Tests
Penicillins
Hypersensitivity
History
Immunoglobulin E
Exanthema
MEDLINE
Skin
Language
Angioedema
Information Storage and Retrieval
Urticaria
Anaphylaxis
Documentation
Asthma
Anti-Bacterial Agents
Physicians
Antibodies

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Penicillin allergy : Prevalence of vague history in skin test-positive patients. / Solensky, R.; Earl, H. S.; Gruchalla, R. S.

In: Annals of Allergy, Asthma and Immunology, Vol. 85, No. 3, 2000, p. 195-199.

Research output: Contribution to journalArticle

@article{12416cfa189d434da49d6705fe3d5a22,
title = "Penicillin allergy: Prevalence of vague history in skin test-positive patients",
abstract = "Objective: Penicillin (PCN) skin testing is a reliable tool for predicting which patients can safely receive the antibiotic. Depending on the study, 7{\%} to 76{\%} of patients who have a history of PCN allergy have positive PCN skin tests. Many physicians approach patients who have a vague history of PCN allergy less cautiously than they approach those who have a convincing history suggestive of an IgE-mediated reaction. We reviewed the published literature to determine how many patients who had a history of PCN allergy and who were skin test-positive had a vague history of allergy. Data Sources: By cross-referencing the keywords {"}penicillin{"} and {"}skin test,{"} an Ovid MEDLINE search for English language studies published from 1966 to 1998 was performed. Study Selection: Studies in which history positive/skin test-positive patients were identified, and which contained documentation of the type of previous reaction in these patients, were included in the analysis. The MEDLINE search revealed 295 English language articles, of which 27 fulfilled the inclusion criteria. Three additional studies published prior to 1966 (and therefore not available through MED-LINE) also were found, bringing the total to 30. A {"}convincing{"} history was defined to be one likely to be IgE-mediated (such as anaphylaxis, urticaria, angioedema or pruritic rash). A {"}vague{"} history was one unlikely to be IgE-mediated (such as maculopapular rash, G1 symptoms, or an unknown reaction). Results: Overall, 347/1063, or 33{\%}, of history positive/skin test-positive patients had a vague PCN allergy history, with a range of 0{\%} to 70{\%} among the 30 studies. Conclusion: A large proportion of patients who have PCN-specific IgE antibodies, as determined by skin testing, have vague PCN allergy histories. These results therefore, indicate that, like patients with convincing histories, patients with vague allergic histories should undergo PCN skin testing prior to PCN administration. Ann Allergy Asthma Immunol 2000;85:195-199.",
author = "R. Solensky and Earl, {H. S.} and Gruchalla, {R. S.}",
year = "2000",
language = "English (US)",
volume = "85",
pages = "195--199",
journal = "Annals of Allergy, Asthma and Immunology",
issn = "1081-1206",
publisher = "American College of Allergy, Asthma and Immunology",
number = "3",

}

TY - JOUR

T1 - Penicillin allergy

T2 - Prevalence of vague history in skin test-positive patients

AU - Solensky, R.

AU - Earl, H. S.

AU - Gruchalla, R. S.

PY - 2000

Y1 - 2000

N2 - Objective: Penicillin (PCN) skin testing is a reliable tool for predicting which patients can safely receive the antibiotic. Depending on the study, 7% to 76% of patients who have a history of PCN allergy have positive PCN skin tests. Many physicians approach patients who have a vague history of PCN allergy less cautiously than they approach those who have a convincing history suggestive of an IgE-mediated reaction. We reviewed the published literature to determine how many patients who had a history of PCN allergy and who were skin test-positive had a vague history of allergy. Data Sources: By cross-referencing the keywords "penicillin" and "skin test," an Ovid MEDLINE search for English language studies published from 1966 to 1998 was performed. Study Selection: Studies in which history positive/skin test-positive patients were identified, and which contained documentation of the type of previous reaction in these patients, were included in the analysis. The MEDLINE search revealed 295 English language articles, of which 27 fulfilled the inclusion criteria. Three additional studies published prior to 1966 (and therefore not available through MED-LINE) also were found, bringing the total to 30. A "convincing" history was defined to be one likely to be IgE-mediated (such as anaphylaxis, urticaria, angioedema or pruritic rash). A "vague" history was one unlikely to be IgE-mediated (such as maculopapular rash, G1 symptoms, or an unknown reaction). Results: Overall, 347/1063, or 33%, of history positive/skin test-positive patients had a vague PCN allergy history, with a range of 0% to 70% among the 30 studies. Conclusion: A large proportion of patients who have PCN-specific IgE antibodies, as determined by skin testing, have vague PCN allergy histories. These results therefore, indicate that, like patients with convincing histories, patients with vague allergic histories should undergo PCN skin testing prior to PCN administration. Ann Allergy Asthma Immunol 2000;85:195-199.

AB - Objective: Penicillin (PCN) skin testing is a reliable tool for predicting which patients can safely receive the antibiotic. Depending on the study, 7% to 76% of patients who have a history of PCN allergy have positive PCN skin tests. Many physicians approach patients who have a vague history of PCN allergy less cautiously than they approach those who have a convincing history suggestive of an IgE-mediated reaction. We reviewed the published literature to determine how many patients who had a history of PCN allergy and who were skin test-positive had a vague history of allergy. Data Sources: By cross-referencing the keywords "penicillin" and "skin test," an Ovid MEDLINE search for English language studies published from 1966 to 1998 was performed. Study Selection: Studies in which history positive/skin test-positive patients were identified, and which contained documentation of the type of previous reaction in these patients, were included in the analysis. The MEDLINE search revealed 295 English language articles, of which 27 fulfilled the inclusion criteria. Three additional studies published prior to 1966 (and therefore not available through MED-LINE) also were found, bringing the total to 30. A "convincing" history was defined to be one likely to be IgE-mediated (such as anaphylaxis, urticaria, angioedema or pruritic rash). A "vague" history was one unlikely to be IgE-mediated (such as maculopapular rash, G1 symptoms, or an unknown reaction). Results: Overall, 347/1063, or 33%, of history positive/skin test-positive patients had a vague PCN allergy history, with a range of 0% to 70% among the 30 studies. Conclusion: A large proportion of patients who have PCN-specific IgE antibodies, as determined by skin testing, have vague PCN allergy histories. These results therefore, indicate that, like patients with convincing histories, patients with vague allergic histories should undergo PCN skin testing prior to PCN administration. Ann Allergy Asthma Immunol 2000;85:195-199.

UR - http://www.scopus.com/inward/record.url?scp=0034489940&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034489940&partnerID=8YFLogxK

M3 - Article

VL - 85

SP - 195

EP - 199

JO - Annals of Allergy, Asthma and Immunology

JF - Annals of Allergy, Asthma and Immunology

SN - 1081-1206

IS - 3

ER -