Penicillin allergy in children : review article

It is not uncommon to see skin rashes during a course of treatment with penicillin and penicillin-based antibiotics. This is often assumed to be due to penicillin allergy although in most cases no testing is performed to verify the diagnosis. Many children are simply labelled 'penicillin allergic', a label which they carry into adulthood which may deny them the benefit of treatment with the most appropriate group of antibiotics. Penicillins are the most widely used antibiotics for common infections as well as being the antibiotics which most often cause allergic reactions. The incidence of self-reported penicillin allergy is 1-10% but most of these patients will test negative. Misdiagnosis of penicillin allergy may result in the unnecessary use of more expensive and less effective antibiotics as well as the emergence of multidrug-resistant organisms. History alone is unreliable in the diagnosis of penicillin allergy. Skin testing (skin-prick and intradermal testing) remains standard practice for the evaluation of patients with immediate hypersensitivity reactions (IgE-mediated) to penicillin. Skin testing combined with a thorough history, determination of specific IgE antibody level and, if indicated, a drug provocation test (DPT) should diagnose the majority of children with penicillin allergy. Patients with proven penicillin allergy can undergo desensitisation if they require penicillin therapy and no alternative is available. Accurate diagnosis of penicillin allergy is essential to avoid the morbidity, mortality and economic cost associated with unnecessary withholding of this drug in nonallergic patients.