Allergy to β-lactams: A survey of current practices

Many issues related to the diagnosis and management of β-lactam drug allergy still await definitive recommendations. To determine how practicing allergists deal with some of these dilemmas, a questionnaire was mailed to 3500 physician members and fellows of the American Academy of Allergy and Immunology. It was also sent to each of the allergy training program directors in the United States to determine what is currently taught to fellows in training. Benzylpenicilloyl-polylysine (Pre-Pen) and fresh penicillin G are used for skin testing by more than 86% of both respondent groups, whereas minor determinant mixtures are used by only 40%. Epicutaneous followed by intradermal injection was the skin test technique used by 86% of these allergists. More than 90% said they would skin test in cases of reaction history of urticaria, whereas only 1.5% would test in cases of family history of penicillin allergy. Practicing allergists and program directors differed slightly when queried about cephalosporin cross-reactivity. Program directors were more cautious in their use of cephalosporins with patients allergic to penicillin. Program directors were also more likely to repeat skin testing before future penicillin courses than were practicing allergists. Clearly, some individual approaches to the diagnosis and management of β-lactam allergy are practiced. Development of practice guidelines by our professional organizations may be useful.