title: One-week oral challenge with penicillin in diagnosis of penicillin allergy.
abstract: Many patients experience reactions during penicillin treatment. The diagnosis may be difficult and is mainly based on short-term tests. The European Network for Drug Allergy (ENDA) guidelines proposed for diagnosing penicillin allergy do not include long-term challenge. In this study a total of 405 patients were evaluated. The ENDA guidelines were extended, to include a 7-day oral treatment (p.o.7) with penicillin for all patients who were negative in the ENDA programme. Among the 405 patients; 85 had an immediate reaction to penicillin, and a further 13 reacted during p.o.7. Among the 307 patients with a negative outcome, 88 had a case history of reaction to other β-lactam antibiotics and were subsequently tested with the culprit drug. Thirteen patients had a positive outcome: 3 on single-dose challenge and 10 during p.o.7. The extended penicillin diagnostic work-up was positive in 111 patients, 30.0% showed immediate reactions and 5.7% reacted during p.o.7. Approximately 20% of all patients with positive outcome during penicillin challenge are detected by adding p.o.7 with penicillin to the original ENDA guidelines.
authors.affiliation: Department of Dermatology and Allergy Centre, Odense University Hospital, DK-5000 Odense, Denmark. janni.hjortlund@ouh.regionsyddanmark.dk
authors.forename: Janni
authors.initials: J
authors.lastname: Hjortlund
authors.forename: Charlotte Gotthard
authors.initials: CG
authors.lastname: Mortz
authors.forename: Per Stahl
authors.initials: PS
authors.lastname: Skov
authors.forename: Esben
authors.initials: E
authors.lastname: Eller
authors.forename: Johan Milling
authors.initials: JM
authors.lastname: Poulsen
authors.forename: Jakob Eli
authors.initials: JE
authors.lastname: Borch
authors.forename: Carsten
authors.initials: C
authors.lastname: Bindslev-Jensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000139:chemically induced; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D003875:Drug Eruptions / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced / Q000175:diagnosis*; D006969:Hypersensitivity, Immediate / Q000139:chemically induced / Q000175:diagnosis*; D007073:Immunoglobulin E; D007159:Immunologic Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D017410:Practice Guidelines as Topic; D013997:Time Factors; D055815:Young Adult; D047090:beta-Lactams / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D047090:beta-Lactams; D007073:Immunoglobulin E