The Rational Clinical Examination
David L. Simel, Drummond Rennie
Penicillin Allergy
David L. Simel, John Foxworth, Alan Salkind
Make the Diagnosis: Penicillin Allergy
Topics Discussed:
allergy to penicillin, criterion standard comparisons (diagnostic tests), likelihood ratio, make the diagnosis, penicillin, penicillin adverse reaction, predictive value, prior probability
Excerpt:
"About 10% of patients will have an adverse reaction
to penicillin, but most will not be penicillin allergic. Less than
1% of all patients will have a true allergy to penicillin,
as defined by an anaphylactic reaction, positive skin test result,
or response to a second dose of penicillin. Physicians should ascertain
the nature of the reaction to help decide whether it might have
represented a true penicillin allergy. An allergy to penicillin
may be difficult to ascertain from the patient's medical
history, primarily because many penicillin reactions do not represent
allergic reactions. The most important finding from a penicillin
history is also the least frequent—patients with severe
reactions (eg, toxic epidermal necrolysis, life-threatening anaphylaxis,
hemolytic anemia, liver damage) should not be skin tested for penicillin allergy
and should not receive penicillin.5..."
Log in to read the full chapter:
Get full access to JAMAevidence two ways:
Subscribe to JAMAevidence
JAMAevidence is a subscription-
based website dedicated to the learning, teaching, and practicing of evidence-based medicine.
Pay Per View
Timed access to all of JAMAevidence
24 hours for $29.95
48 hours for $49.95