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The key to penicillin allergy delabeling

Tool KitsIn-Patient EvaluationOut-Patient EvaluationAssessment of ChildrenPerioperative Evaluation
Patient Questionnaires
Antibiotic Reactions TimelinePenicillin Skin TestingContraindications Amoxicillin Challenge
FAQsTerminologyWhat are the facts about penicillin allergy?What are the consequences of being labeled penicillin allergic?What is the cross reactivity between Penicillin and cephalosporins?Is Penicillin Allergy necessarily forever?How Are Antibiotic Allergies Classified?What types of allergic reactions occur with Penicillin and beta-lactams?What is SCARs?What is needed to clinically evaluate a patient with a reported Penicillin allergy?Can you do a risk stratification for beta-lactam allergic patients?How is a patient with a Penicillin/cephalosporin allergy managed?Can cefalozin be given to Penicillin allergic patients for perioperative prophylaxis?How can we delabel children with a penicillin allergy
BIBLIOGRAPHYReview ArticlesReferences

Terminology - Review

  • Beta-lactam Antibiotics
Penicillins
  • Ampicillin/Amoxicillin
  • Nafcillin
  • Oxacillin
  • Piperacillin
Cephalosporins
  • Ceftriaxone 
  • Cefazolin 
  • Cefepime 
  • Cephalexin
Carbapenems 
  • Imipenem 
  • Meropenem 
  • Ertapenem
Monobactam 
  • Aztreonam
  • AGEP - Acute generalized exanthematous pustulosis
  • Allergic reaction
    • Immediate = IgE – mediated = anaphylaxis or other manifestations
  • Anaphylaxis – requires signs or symptoms in at least 2 of the following systems:
    • *Skin: Hives, flushing, itching and/or edema
    • *Respiratory: Cough, nasal congestion, shortness of breath, chest tightness, wheeze, sensation of throat closure or choking and/or change in voice-quality (laryngeal edema)
    • *Cardiovascular: Hypotension, faintness, tachycardia/bradycardia, tunnel vision, chest pain, sense of impending doom and/or loss of consciousness
    • *Gastrointestinal: Nausea, vomiting, abdominal cramps, and diarrhea
  • Angioedema – localized edema without hives affecting the abdomen, face, extremities, genetalia, oropharynx or larynyx
  • BLA – Beta-lactam allergy
  • CADRs - Cutaneous adverse drug reactions
  • DRESS – Drug reaction with eosinophilia and systemic symptoms
  • PCN – Penicillin
  • Penicillin Skin Test (PST) - surrogate marker for immediate (IgE - mediated) reaction
  • PST – Penicillin skin test
  • SCAR – Severe cutaneous allergic reaction
  • S-3Ts:
    • *Symptoms
    • *Tolerance
    • *Timing of reaction
    • *Time since reaction
  • SJS – Stevens-Johnson Syndrome
  • Skin Reactions:
    • * Maculopapular rash – characterized by a flat, red area on the skin that is covered with small confluent bumps
    • * Urticaria/hives – characterized by very itchy raised, skin-colored area with or without surrounding erythema
  • SS - Serum sickness
  • SSLR - Serum sickness-like reaction
  • TEN – Toxic epidermal necrolysis