Approach to Penicillin Allergy – A Survey

Individual approaches to the diagnosis and management of penicillin allergy are practiced by clinicians. This cross-sectional survey of physicians was aimed at exploring their ways of dealing with diagnosis and management of penicillin G allergy. Of the 235 respondents, 63% believed patients’ self-reported history of penicillin allergy and avoided using penicillin G; 97% do so for patients whose allergic status was confirmed with positive skin test results. Researchers insist on skin testing for patients claiming penicillin allergy and for those whose allergic status was confirmed with positive skin test results, before considering antibiotic substitution, in an attempt to minimize the development of multi drug resistant pathogens. Undue concern about penicillin allergy may negatively influence the therapeutic outcome of rheumatic fever and syphilis. Repeated skin testing is recommended before each subsequent course of penicillin G, even in patients who have tolerated it before which was practiced by an appreciable number (89%) of our respondents. Epi cutaneous followed by intra dermal routes with major and minor determinants have been recommended for penicillin G skin testing. 100% of our respondents skin tested by intra dermal route alone, using penicillin G and its repository preparations before injecting the respective full dose preparations. Legal problems arising from serious clinical outcomes of penicillin allergy may pose a threat to the physician of losing self esteem in the society forcing him to be overcautious with its use. Educating both the public and health care providers is necessary in this regard.