Burke A Cunha MDab

aState University of New York School of Medicine, Stony Brook, NY, USA bInfectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501, USA

Many individuals with an infectious disease have a history of penicillin allergy. When a patient says that he or she is allergic to penicillin, the physician should clarify the nature of the penicillin allergy. Many patients do not, in fact, have a true penicillin allergy but rather an adverse effect to the medication, such as gastrointestinal intolerance, which is not related to drug allergy. The spectrum of penicillin allergy ranges from drug fever to anaphylactic reactions. After the nature of the penicillin allergy is determined, the clinician then selects an antimicrobial appropriate for the infectious disease being treated, while taking into account the patient's allergy history. In clinical practice, it is rarely if ever necessary to do skin testing for a penicillin allergy. Because so many antibiotics have no cross-allergenic-ity to penicillin, clinicians can almost always select an appropriate and safe antimicrobial for the penicillin-allergic patient. Skin testing for penicillin allergy and desensitization are rarely necessary in the hospital or outpatient setting [1-6].

Multiple drug hypersensitivity reactions are stereotyped in nature. In penicillin-allergic patients who develop a maculopapular rash to penicillins, the penicillin allergy has the same clinical manifestation on rechallenge. Re-exposure to penicillin will not result in a rash, hives, or anaphylaxis. This principle is important in selecting antimicrobial therapy in the penicillin-allergic patient. Clinicians can take comfort in being able to predict the type of penicillin reaction if a patient, upon re-exposure to the drug, has a hypersensitivity reaction. Physicians unaware of this fact usually are concerned that patients with a rash may develop hives or anaphylaxis. This is not the case. Hypersensitivity drug reactions are stereotyped and there is no progression of severity with repeated exposure. If the nature of the

* Infectious Disease Division, Winthrop-University Hospital, 222 Station Plaza North, Suite 432, Mineola, NY 11501.

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