8 responses to “Evaluation of penicillin allergy”

  1. Very good comments. As the author mentioned many of these reactions are viral exanthema or even an amoxil rash with Mono.

    However referral to an allergist for most patients is not feasible or cost effective. Lab testing is also costly.

  2. Great article

  3. Great summary of the issue and a rational approach.

  4. Thanks for clarifying this rational approach. Many allergists (apparently) also provide a test dose under medical supervision to clinincally rule out reactivity (as per https://www.uptodate.com/contents/significance-of-negative-penicillin-allergy-skin-testing-beyond-the-basics).

  5. Observe that penicillin allergy is less apparent in the elderly

  6. Thank you for addressing this important topic. I am wondering if you can comment on an approach to Type IV/maculopapular rashes following amoxicillin in children as this is so common. While skin tests may not be appropriate for all affected, it also doesn’t necessarily seem appropriate to write off beta-lactams for life for all the reasons addressed in your article. Could you please provide some child-specific recommendations, thank you!

  7. Most “penicillin allergies” are likely viral exanthems of childhood. Do we skin test all of them?

  8. Hi,

    Sorry, I am really slow on responding. I also don’t know how to log on as author, but for mild reactions in childhood (assuming the patient is now an adult) I offer to give a test-dose under medical supervision and by-pass the skin testing step as the likelihood of anaphylactic reaction is very low. I do discuss the risk/benefit with patients including the very small likelihood of a more severe reaction but reassure the patient that we will observe and treat them in the case of reaction to the test dose. This process also addresses the lack of resources for skin testing.

    Of interest, several places have created a “skin testing team” staffed by nurses or pharmacists trained to read the skin reaction, making skin testing easier to access and more timely for inpatients who need immediate antibiotic therapy. See these links:



    Hope that helps

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