The rational clinical examination. Is this patient allergic to penicillin? An evidence-based analysis of the likelihood of penicillin allergy.

@article{Salkind2001TheRC,
  title={The rational clinical examination. Is this patient allergic to penicillin? An evidence-based analysis of the likelihood of penicillin allergy.},
  author={Alan R. Salkind and Paul G. Cuddy and John W. Foxworth},
  journal={JAMA},
  year={2001},
  volume={285 19},
  pages={
          2498-505
        }
}
CONTEXT Clinicians frequently withhold antibiotics that contain penicillin based on patients' self-reported clinical history of an adverse reaction to penicillin and the clinicians' own misunderstandings about the characteristics of a true penicillin allergy. OBJECTIVES To determine the likelihood of true penicillin allergy with consideration of clinical history and to evaluate the diagnostic value added by appropriate skin testing. DATA SOURCES MEDLINE was searched for relevant English… 

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References

SHOWING 1-10 OF 58 REFERENCES
Allergy to penicillin: fable or fact?
TLDR
Most patients who gave a history of penicillin allergy are not so allergic, and their actual allergic state should be substantiated whenever feasible, and for patients reporting minor or vague reactions negative findings with a radioallergosorbent test to phenoxymethylpenicillin and benzylPenicillin provide sufficient evidence to give oral penicillian safely.
A perspective on penicillin allergy.
  • R. Lin
  • Medicine
    Archives of internal medicine
  • 1992
TLDR
The current and past literature was reviewed in an attempt to develop practical treatment approaches and to identify clinical questions that need further investigation related to penicillin allergy.
Risk of administering cephalosporin antibiotics to patients with histories of penicillin allergy.
  • S. Anné, R. Reisman
  • Medicine, Biology
    Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
  • 1995
TLDR
Data indicate that it is safe to administer cephalosporin antibiotics to penicillin-allergic patients andPenicillin skin tests do not identify potential reactors, and post-marketing studies of second and third generation cep Halosporins showed no increase in allergic reactions in patients with penicillillin allergy histories.
Penicillin skin testing: a way to optimize antibiotic utilization.
The role of skin testing for penicillin allergy.
To the Editor.— We believe that a recent article by Redelmeier and Sox 1 has left readers with an erroneous perception regarding the utility of penicillin skin testing. Redelmeier and Sox state that
Diagnosis of penicillin allergy by skin testing: the Manitoba experience.
TLDR
Of 169 patients reacting negatively to skin testing who received a specific drug challenge only 2 manifested mild urticaria; this indicates the reliability of the skin tests in predicting penicillin allergy.
Prediction of penicillin allergy by immunological tests.
Routine elective penicillin allergy skin testing in children and adolescents: study of sensitization.
Immediate hypersensitivity reactions to penicillin and related antibiotics
TLDR
Allergenicity of penicillins is the major clinical problem that precludes the use of this class of antibiotics in a significant portion of the general population who are believed to be sensitive.
Penicillin allergy: anti-penicillin IgE antibodies and immediate hypersensitivity skin reactions employing major and minor determinants of penicillin.
TLDR
It was concluded that penicillin allergy is often overdiagnosed and the diagnosis can be reliably confirmed by skin tests using major and minor determinants of benzylpenicillin and by the radioallergosorbent test; such hypersensitivity is not permanent.
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