Do not avoid all beta-lactams in patients reporting penicillin allergies.
Penicillin allergy is over reported and cross-allergy between penicillins and cephalosporins is overestimated.
Table 1: Onset, symptoms, and management options for various beta-lactam associated reactions
Reaction | Onset | Symptoms | Management options |
---|---|---|---|
Hypersensitivity
|
Usually <1 hour (max 72 hours) |
Anaphylaxis, urticaria, angioedema, laryngeal edema, wheeze, hypotension |
Do not give the same drug again. Choose another cephalosporin with a different side chain. Do not give another penicillin if culprit was a penicillin. |
|
>72 hours |
Non-serious2 Contact dermatitis, pruritic maculopapular eruption |
Not a contraindication to using a beta-lactam. Consider provocation challenge or an antibiotic with a different side chain. |
Serious or life-threatening3 | AVOID all beta-lactams | ||
Non-hypersensitivity | Anytime | Gastrointestinal symptoms, flushing during infusion, headache, yeast infection, isolated itch | Not a contraindication to using a beta lactam |
1Skin testing has no role in the diagnosis of non-IgE mediated reactions.
2>90% of rashes occurring after people take penicillin (amoxicillin) are mild non-IgE reactions. Rashes occur in up to 7% of people.
3Serious or life-threatening non-IgE mediated hypersensitivity reactions are rare with beta-lactams. They include Stevens-Johnson syndrome, topix epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, hemolytic anemia, interstitial nephritis, hepatitis, and serum sickness.
Last reviewed August 2020
Last reviewed August 2020
Last reviewed August 2020
Cefazolin is the drug of choice for surgical prophylaxis
Can patients with a beta-lactam allergy receive cefazolin safely?
Last reviewed August 2020