Penicillin allergy-Truth or duty?

Abstract

The beta-lactam antibiotics are some of the safest and best-tolerated antibiotic agents; however, many patients have reported allergies against penicillin. All beta-lactam antibiotics are only restrictively prescribed for these patients and alternative antibiotics are increasingly given, which carries the risk of negative clinical results and socioeconomic sequelae; however, over 95% of patients who reported an allergy to penicillin show anegative result in the allergy tests for penicillin and this antibiotic can safely be prescribed. The use of sensitive and specific instruments for identification of false penicillin allergies should be an important topic within the framework of antibiotic stewardship. Anesthesists can play acentral role in the reduction of the enormous individual and public health burden associated with the classification of penicillin allergy by taking an appropriate medical history and arisk stratification for the identification of patients with apenicillin allergy. This overview article presents apossible delabelling algorithm within the framework of the clarification of abeta-lactam antibiotic allergy. The focus is on astructured allergy anamnesis using the penicillin allergy, five or fewer years ago, anaphylaxis/angioedema, severe cutaneous adverse reaction (SCAR) and treatment required for allergy episode (PEN-FAST) score.