Abstract

Background: In Europe, North America, and Australia, 5% to 10% of the population are now classified as penicillin (β-lactam) allergic. Only ~ 10% of these questionable diagnoses, mostly made in childhood, can be confirmed by allergy diagnostics. Materials and methods: The aim of this review is to show causes and consequences as well as recommendations for dealing with the often questionable diagnosis of penicillin (β-lactam) allergy (BLA). Results: An incorrect BLA diagnosis may negatively impact antibiotic treatment needed in the future, by using a less effective antibiotic or using a broad-spectrum antibiotic, for example, further exacerbating the problem of increasing antibiotic resistance. Accordingly, there is growing pressure from antibiotic stewardship programs to critically challenge the BLA diagnosis. Conservatively, a suspected BLA is reviewed by an allergist using medical history, skin testing, laboratory testing, and provocation. This clarification is costly and is not remunerated in the German health care system; that is the reason why this testing is only offered in a few specialized clinics and practically not at all in general practice. In view of thousands of affected patients, additional strategies are needed to treat patients with a low risk of hypersensitivity reaction despite suspected allergy with a β-lactam antibiotic. In recent years, various methods have been proposed to eliminate suspected allergy as promptly as possible and directly before necessary treatment with a β-lactam antibiotic, including standardized history (also in the form of an algorithm), skin test with immediate reading after 15 minutes, or administration of a small test dose. Investigations of small case series and also multi-center studies to date have yielded promising results in terms of feasibility and safety. Conclusion: Of the large number of patients with (questionable) BLA, most have never been tested and – if antibiotic treatment becomes necessary – simply receive an alternative antibiotic. The diagnosis of BLA therefore requires new approaches besides classical allergy testing to critically question BLA.

Author Details

Authors

• Knut Brockow¹
• Gerda Wurpts²
• Axel Trautmann³

Departments

• ¹ Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich,
• ² Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital of RWTH Aachen, and
• ³ Department of Dermatology and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, Germany

Address

Prof. Dr. Knut Brockow, Department of Dermatology and Allergology Biederstein, Faculty of
Medicine, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
Email: [email protected]

Citation