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To the Editor: In their Rational Clinical Examination article, Dr Salkind and colleagues¹ recommend that "taking a detailed history of a patient's reaction to penicillin may allow clinicians to exclude true penicillin allergy, allowing these patients to receive penicillin." This advice is potentially dangerous. The reason this practice appears to be successful is the relatively low frequency of anaphylaxis, not because the history is predictive.

The history of penicillin allergy, including potential IgE-mediated reactions such as anaphylaxis and hives, does not correlate with skin test positivity,² the closest test to a criterion standard for allergy. Mild, possibly nonallergic reactions such as delayed-onset rashes do not increase the probability of a negative skin test and a history of anaphylaxis does not increase the odds of a positive test. The bottom line is that penicillin allergy histories are too unreliable to rechallenge a patient without documenting safety by penicillin skin testing first.

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RELATED ARTICLE

Is This Patient Allergic to Penicillin?: An Evidence-Based Analysis of the Likelihood of Penicillin Allergy
Alan R. Salkind, Paul G. Cuddy, and John W. Foxworth
JAMA. 2001;285(19):2498-2505.
ABSTRACT | FULL TEXT