Is type I penicillin allergy overdiagnosed in children?

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.

A two-year follow-up of children with urticaria in general practice

A questionnaire was sent in 1984 to 97 children with urticaria, who had previously been seen in Danish general practice during a period of three months in 1982. The questionnaire included questions about provoking factors and the course of the disease. Replies were received from 79 children, 46 of whom had experienced one attack only, and 33 had had several attacks. Fifteen percent of the former and 48% of the latter suggested a variety of provoking agents, which were mainly food and food additives in the recurrent group. Previous infections were not suspected, though 20% had signs or symptoms of infection at the registration in 1982. It is suggested that a first episode of urticaria should be investigated by the practitioner only, with simple questioning and perhaps symptomatic treatment, because the first attack is often the sole one.