CONCLUSION
The incidence of penicillin allergy in the general population has been estimated to be between
1% and 10%, but no good reliable data exist on the actual incidence of penicillin allergy.
Penicillin data derived from penicillin skin testing does not correlate with penicillin reactions
in the clinical setting. Many patients reporting penicillin allergy have in fact had reactions to
penicillin, which are not on an allergic basis. Penicillin reactions are of the non-anaphylatic or
anaphylactic variety if they are indeed penicillin reactions. Penicillin reactions may occur on a
single exposure to a penicillin orb-lactam antibiotic. From questioning or previous history,
patients’ bona fide penicillin reactions may be classified as anaphylactic or non-anaphylactic.
Because the cross-reactivity betweenb-lactams and penicillin is so low,b-lactam antibiotics
may be used in patients who have had drug fever or a drug rash as the primary manifestation
of their penicillin allergy. Should the patient develop an allergic cross-reaction between the
b-lactam and the penicillin, the allergic manifestation will be of the same type as encountered
previously.
In patients with a history of anaphylactic reactions to penicillin, it is essential to use a non
b-lactam antibiotic, i.e., a carbapenem, monobactam, quinolone, clindamycin, TMP/SMX,
quinupristin/dalfopristin, linezolid, vancomycin, daptomycin, clindamycin, metronidazole,
polymyxin B, or an aminoglycoside. As with non-anaphylactic penicillin cross-reactions,
anaphylactic reactions to penicillin also tend to be stereotyped, and upon repeated exposure
have the same clinical expression as initially manifested in their allergic response. It is
important to remember that although meropenem is structurally ab-lactam, meropenem also
does not cross react with those with penicillin allergies, including those with anaphylactic
reactions (27–31). This has been shown in a large prospective clinical study (32,33).
Because the therapeutic armamentarium at the present time is so extensive, it is rarely
necessary to de-sensitize a patient in the critical care setting to receive ab-lactam when so
many antibiotics are available and effective.
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