Penicillin allergies: referral and management practices of anesthesiologists

Rationale Penicillin and other beta-lactams are the most commonly used antibiotics due to their narrow spectrum of activity, low cost and safety profile. However, an “allergy” to Penicillin is also the most commonly reported allergy. Approximately, 5-10% of all patients self-report an allergy to Penicillin and of these <10% are found to have true IgE mediated allergy on skin testing. Numerous studies have confirmed the usefulness and strong negative predictive value (>99%) of skin testing to rule out true IgE mediated Penicillin allergy. Less than 10% of patients with a history of penicillin allergy are found to be actually allergic to penicillin on skin testing. Despite this, most physicians forgo further investigations in favor of the usage of alternative antibiotics.