Anaphylaxis after oral penicillin

Allergy to penicillin: fable or fact?

OBJECTIVE

To assess whether, on the basis of one blood test, penicillin allergy might be excluded sufficiently for general practitioners to give oral penicillin to patients claiming a history of penicillin allergy.

DESIGN

Prospective study of patients referred by general practitioners.

SETTING

Outpatient allergy clinic in a district general hospital.

PATIENTS

175 referred patients who gave a history of immediate type reaction to penicillin, of whom 144 attended as requested and 132 completed the investigations.

MAIN OUTCOME MEASURES

History and examination, serum radioallergosorbent test to phenoxymethylpenicillin and benzylpenicillin, and oral challenge with penicillin.

RESULTS

Of 132 patients, four were confirmed to have penicillin allergy by the radioallergosorbent test and 128 had an oral penicillin challenge without ill effect.

CONCLUSIONS

Most patients who gave a history of penicillin allergy are not so allergic, and their actual allergic state should be substantiated whenever feasible. For patients reporting minor or vague reactions negative findings with a radioallergosorbent test to phenoxymethylpenicillin and benzylpenicillin provide sufficient evidence to give oral penicillin safely.

Penicillin anaphylaxis

A case of oral penicillin anaphylaxis is described, and the terminology, occurrence, clinical manifestations, pathogenesis, prevention, and treatment of anaphylaxis are reviewed. Emergency physicians should be aware of oral penicillin anaphylaxis in order to prevent its occurrence by prescribing the antibiotic judiciously and knowledgeably and to offer optimal medical therapy once this life-threatening reaction has begun.

QT prolongation after ampicillin anaphylaxis

Tall T waves and pronounced prolongation of the QT interval developed 24 hours after an apparently complete recovery from an acute anaphylactic reaction to oral ampicillin in a previously healthy woman of 29. These electrocardiographic abnormalities gradually subsided over five days. The prolongation of the QT interval has not previously been reported after anaphylaxis.

The course, costs and complications of oral versus intravenous penicillin therapy of erysipelas

Oral versus intravenous antibiotic therapy of severe erysipelas was compared in a controlled trial of 60 patients. No clinical benefit of intravenous therapy was found, as evaluated by fever duration, hospital stay and sick leave. Untoward reactions were comparable between the groups. No difference in recurrence was found. The difference in administration time and drug cost was considerable. It is therefore suggested that erysipelas without complications should be treated orally.