Fatal and near-fatal penicillin anaphylaxis: Three new cases with a note on prevention

Abstract

1. 1. One death and two cases of nonfatal anaphylactic shock due to penicillin are described. 2. 2. The fatality occurred in a patient with bronchial asthma. Three other known deaths attributable to penicillin anaphylaxis have also occurred in asthmatics. 3. 3. Two of these patients, including the one with a fatal reaction, had received penicillin many times before without indication of allergy. The third patient responded previously with immediate reactions to penicillin which went unheeded as a warning of anaphylaxis. 4. 4. A direct scratch test with aqueous crystalline penicillin was positive in one case, whereas similar tests were negative with aqueous procaine penicillin and 2 per cent procaine. Passive transfer tests were negative. 5. 5. Detailed precautions are suggested toward the prevention of penicillin anaphylaxis, particularly for asthmatic and penicillin-allergic persons. The avoidance of the indiscriminate use of penicillin, particularly by injection, is emphasized. The value of a systematic inquiry as to previous penicillin treatment and reactions as well as of the general allergic status is stressed. Certain refinements in the method of penicillin injection are suggested. The technique and interpretation of preliminary penicillin skin tests are discussed.