Management of tolerance induction in patients with suspected penicillin allergy – a case study

Abstract

This case study demonstrates that a suspected allergy to penicillin does not preclude an eventual treatment with this valuable drug. Allergy testing should routinely be carried out first. If suspicion of an allergy persists, tolerance induction can be attempted according to the new scheme described here. Starting with a careful, initial oral dose regimen, treatment can be continued with an increasing intravenous dose followed by maintenance therapy with high-dose penicillin G. It should be clear that this policy is only restricted for patients who are at risk for a hypersensitivity to penicillin, i.e., because of a clinical manifested incompatibility in the past.

Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group

“…The pharmacokinetics of both the drugs, especially the influence of metabolites, should be considered and be particularly observed. In patients with exanthems, most often slow protocols with gradually increasing doses have been used, which last from hours (Table ) to days (Table ) to several weeks . Whereas rush protocols have the clear advantage over slow protocols because full therapeutic doses of the drug in question can be reached within a few hours or 1 to 2 days, they also exhibit higher risks and failure rates.…”