When to Test for a Penicillin Allergy

In this Clinical Decisions article from the New England Journal of Medicine, two experts debate the evidence for and against directly challenging a low-risk patient with a penicillin allergy.

A college student presents to the campus health clinic and is diagnosed with group A streptococcal pharyngitis. The clinician learns about a penicillin allergy dating back to age 2, when the patient developed a rash and diarrhea after taking an unspecified antibiotic. He has had no allergic reactions since. The clinician must decide: Should penicillin be prescribed under observation now, or should a nonpenicillin antibiotic be used with referral to an allergist? Two clinicians, an allergist and a primary care physician, provide their answers and perspectives.

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The case vignette should feel very familiar to many of us: a patient with a remote history of a penicillin allergy without obvious anaphylactic symptoms. Only ≈2% of labeled peni…

Ann Cheung, MD, MBA, MSCommentary Author

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Nothing to disclose

Ann Cheung, MD, MBA, MSCommentary Author

Disclosures

Nothing to disclose

Authors

Harleen Marwah, MD

Allison Ramsey, MD

Eric M. Macy, MD

When to Test for a Penicillin Allergy

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