CoChat
Sign Up
Cited by 831Drug-Induced Adverse ReactionsPharmacovigilance and Adverse Drug ReactionsFood Allergy and Anaphylaxis Research

The DOI matches its Crossref record; 107 of the 116 references it cites were found in a registry or an index.

Evaluation and Management of Penicillin Allergy: A Review

Shenoy, Erica S., Macy, Eric, Rowe, Theresa, Blumenthal, Kimberly G.·2019·JAMA
DOI 10.1001/jama.2018.19283
Open this paper in CoChat — free account

Abstract

IMPORTANCE: β-Lactam antibiotics are among the safest and most effective antibiotics. Many patients report allergies to these drugs that limit their use, resulting in the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance and adverse events. OBSERVATIONS: Approximately 10% of the US population has reported allergies to the β-lactam agent penicillin, with higher rates reported by older and hospitalized patients. Although many patients report that they are allergic to penicillin, clinically significant IgE-mediated or T lymphocyte-mediated penicillin hypersensitivity is uncommon (<5%). Currently, the rate of IgE-mediated penicillin allergies is decreasing, potentially due to a decreased use of parenteral penicillins, and because severe anaphylactic reactions to oral amoxicillin are rare. IgE-mediated penicillin allergy wanes over time, with 80% of patients becoming tolerant after a decade. Cross-reactivity between penicillin and cephalosporin drugs occurs in about 2% of cases, less than the 8% reported previously. Some patients have a medical history that suggests they are at a low risk for developing an allergic reaction to penicillin. Low-risk histories include patients having isolated nonallergic symptoms, such as gastrointestinal symptoms, or patients solely with a family history of a penicillin allergy, symptoms of pruritus without rash, or remote (>10 years) unknown reactions without features suggestive of an IgE-mediated reaction. A moderate-risk history includes urticaria or other pruritic rashes and reactions with features of IgE-mediated reactions. A high-risk history includes patients who have had anaphylaxis, positive penicillin skin testing, recurrent penicillin reactions, or hypersensitivities to multiple β-lactam antibiotics. The goals of antimicrobial stewardship are undermined when reported allergy to penicillin leads to the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance, including increased risk of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. Broad-spectrum antimicrobial agents also increase the risk of developing Clostridium difficile (also known as Clostridioides difficile) infection. Direct amoxicillin challenge is appropriate for patients with low-risk allergy histories. Moderate-risk patients can be evaluated with penicillin skin testing, which carries a negative predictive value that exceeds 95% and approaches 100% when combined with amoxicillin challenge. Clinicians performing penicillin allergy evaluation need to identify what methods are supported by their available resources. CONCLUSIONS AND RELEVANCE: Many patients report they are allergic to penicillin but few have clinically significant reactions. Evaluation of penicillin allergy before deciding not to use penicillin or other β-lactam antibiotics is an important tool for antimicrobial stewardship.

Overview

Integrity signals

Registry

Crossref · 10.1001/jama.2018.19283

Cites

107 of 107 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Show all 116 references

Cited by

Sorted by citations

Items 301–400 of 831

Related

See all

Metadata

Authors
Shenoy, E. S., Macy, E., Rowe, T., & Blumenthal, K. G.
Affiliations
  • Harvard University (US)
  • Department of Allergy, Southern California Permanente Medical Group, San Diego Medical Center
  • Northwestern University (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2019-01-15
Volume
321
Issue
2
Pages
188
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2018.19283
OpenAlex
W2909667144
Cited by
830
References
116
Citations by year
2026: 109 · 2025: 120 · 2024: 130 · 2023: 132 · 2022: 100 · 2021: 90 · 2020: 89 · 2019: 58
FWCI
10.82
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology (medical) › Drug-Induced Adverse Reactions
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
  • Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
Keywords
penicillin allergy, beta-lactam antibiotics, IgE-mediated hypersensitivity, penicillin skin testing, antimicrobial stewardship, broad-spectrum antibiotic use, antimicrobial resistance, Clostridium difficile infection, methicillin-resistant Staphylococcus aureus
MeSH terms
Amoxicillin, Anti-Bacterial Agents, Desensitization, Immunologic, Drug Hypersensitivity, Female, Humans, Immunoglobulin E, Immunologic Tests, Penicillins, Pregnancy, beta-Lactams, Patient Acuity

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review