Advances in the diagnosis and management of penicillin allergy

IgE-mediated acute systemic reactions to penicillin continue to be an important clinical problem. Advances in our understanding of the immunochemistry of penicillin allergy have improved our ability to predict and to avoid these reactions. Immunodiagnostic techniques can identify patients at risk for anaphylaxis to beta-lactam antibiotics with a high degree of precision. Clinical and immunologic studies have demonstrated that penicillin allergic subjects may have allergic reactions to cephalosporins although the absolute frequency of clinical cross-reactions is not clear. If beta-lactam drugs are needed for treatment of penicillin allergic patients, acute desensitization appears to be an acceptably safe procedure for avoiding anaphylaxis.