Penicillin allergy evaluation: Experience from Clinic of Allergology and Immunology, Clinical Center of Serbia

Introduction: Beta(β)-lactam antibiotics are one of the most prescribed medical drugs worldwide. The incidence of self-reported penicillin allergy ranges from 1 to 10 percent. Patients with registered allergy on β-lactam antibiotics are treated with drugs of second choice which are usually more toxic and more expensive. Aim: The aim of this study was to exam the prevalence of penicillin allergy and correlation of clinical, laboratory and socio-demographic characteristic of patients with and without hypersensitivity to penicillin which were available in medical records. Material and methods: This retrospective, descriptive study included consecutive patients, which were treated in Clinic of Allergology and Immunology, Clinical Center of Serbia (CCS), in the period between the years 2010-2015. Anamnestic data of patients with self-reported allergic reaction to penicilin and the rest of β-lactam antibiotics were used, as well as results of in vivo and in vitro tests. Results: 81 patients were evaluated in the study, of which 59 (72.8%) were females. The average age of patients was 41.7±16.47 years. Adverse effects to penicillin were reported by 70/81 (86.4%) tested patients. In accordance with other studies, the most common initial symptoms were rash (exanthema) and angioedema. None of the 70 patients with self-reported allergic reaction to penicillin had positive in vitro tests. Total number of patients with positive in vivo tests is 2/81 (2.5%) Conclusion: Despite a small percentage of positive penicillin hypersensitivity tests of patients with anamnestic data of self-reported allergic reaction, it is necessary to perform in vivo drug provocation test as a gold standard for confirmation of penicillin hypesensitivity in order to reduce the utilization of alternative antimicrobial drugs, the risk of microbial resistance and treatment costs.