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={A. Salkind and P. Cuddy and J. 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… Expand
View on PubMed
com-dom-im.sites.medinfo.ufl.edu
192 Citations
Highly Influential Citations
4
Background Citations
30
Methods Citations
1
Results Citations
4

192 Citations

Citation Type

Citation Type

The Cost of Self-Reported Penicillin Allergy: A Systematic Review.
TLDR
Evaluations of clinical and economic outcomes of PCN allergy are primarily observational and focus on inpatient populations, with the most frequently measured outcome in the context ofPCN allergy was optimizing antibiotic therapy. Expand
Clinical history as a predictor of penicillin skin test outcome.
  • B. Wong, P. Keith, S. Waserman
  • Medicine
  • Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
  • 2006
TLDR
Regression analysis showed that age, sex, and clinical history, including type of reaction, time of reaction after penicillin ingestion, or time since the last reaction, were not associated with skin test positivity. Expand
Utility of penicillin allergy testing in patients presenting with a history of penicillin allergy
TLDR
A minority of patients presenting with a history of penicillin allergy have evidence of immune-mediated hypersensitivity in this study, demonstrating the usefulness and discriminating power of objective testing, which must include three-day oral challenge. Expand
Penicillin skin testing in the evaluation and management of penicillin allergy.
  • Stephanie J. Fox, M. Park
  • Medicine
  • Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
  • 2011
TLDR
It is found that the major determinant (benzylpenicillin polylysine) detects the greatest number of penicillin allergic patients during skin testing, and the minor determinants of Penicillin increase the sensitivity of peniillin skin testing. Expand
Patient and Primary Care Physician Perceptions of Penicillin Allergy Testing and Subsequent Use of Penicillin-Containing Antibiotics: A Qualitative Study.
TLDR
Clinicians would benefit from information about penicillin allergy testing to be able to use these services appropriately, and to discuss referral with patients, as well as patients who had attended testing and reported benefits of the test. Expand
A clinical decision-making algorithm for penicillin allergy
TLDR
A clinical algorithm based on the patient’s clinical history of the supposed allergic event to penicillin misclassified 3/41 truly allergic patients cannot recommend the use of this algorithm in general practice, however, it can be useful in emergency situations in hospital settings. Expand
A real-time prospective evaluation of clinical pharmaco-economic impact of diagnostic label of ‘penicillin allergy’ in a UK teaching hospital
TLDR
Obtaining a structured history from the patient and family physician alone can enable an accurate identification of penicillin allergy status and total acquisition cost of second-line antibiotics is higher than if these patients were prescribed first- line antibiotics. Expand
Clinical and genetic risk factors of self-reported penicillin allergy.
TLDR
Self-reported penicillin allergy may be influenced by clinical and genetic factors such as IL4, which is linked to immediate hypersensitivity in patients denied beta-lactam antibiotics. Expand
Skin testing and oral penicillin challenge in patients with a history of remote penicillin allergy.
  • A. Goldberg, R. Confino-Cohen
  • Medicine
  • Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
  • 2008
TLDR
Positive peniillin skin test results for patients with a remote history of non-life-threatening allergic reaction to penicillin were not associated with a greater prevalence of adverse reactions to oral challenge withPenicillin than negative results. Expand
Allergy to beta-lactams in pediatrics: a practical approach.
TLDR
The present article underscores the basic body of knowledge on allergy to penicillin, providing support for a more accurate diagnosis of this event and for the choice of management in cases of suspected beta-lactam allergy. Expand
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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. Expand
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. Expand
Risk of administering cephalosporin antibiotics to patients with histories of penicillin allergy.
  • S. Anné, R. Reisman
  • Medicine
  • 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. Expand
Penicillin skin testing: a way to optimize antibiotic utilization.
TLDR
To test the hypothesis that performing penicillin skin testing as part of an antibiotic control strategy was feasible and could improve outcomes, a pilot study of 100 consecutive patients with a history ofPenicillin allergy was conducted. Expand
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… Expand
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. Expand
Prediction of penicillin allergy by immunological tests.
TLDR
Skin tests were found to be valuable predictive tests for immediate (including anaphylactic) and accelerated urticarial allergic reactions to penicillin. Expand
Routine elective penicillin allergy skin testing in children and adolescents: study of sensitization.
TLDR
Penicillin allergy testing procedure in children and adolescents with a history of allergy to penicillin or certain analogs is a safe, highly predictive, nonsensitizing office procedure in the hands of physicians experienced with skin testing. Expand
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. Expand
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. Expand
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