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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Penicillin Allergy
David L. Simel, John Foxworth, Alan Salkind
The lack of a previous reaction does not guarantee that the child will have no future reaction to...

Topics Discussed: penicillin, penicillin adverse reaction, penicillin allergy

Excerpt: "The lack of a previous reaction does not guarantee that the child will have no future reaction to penicillin or a penicillin derivative, but the risk is low (about 1%). You can confidently prescribe penicillin as the preferred antibiotic. Had the child experienced a previous reaction, the clinician would have to make a decision. The risk that such a child is truly allergic to penicillin is greater, given a previous reaction, even though the absolute risk is low. The decision for how to proceed may depend on your assessment of the previous reaction, the need for penicillin vs alternative antibiotics, and the availability of penicillin testing. If the previous reaction was well documented or an immediate reaction, erythromycin is an inexpensive treatment for streptococcal pharyngitis so that urgent skin testing is not necessary...."
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