Unverified penicillin allergy is becoming more recognised as a public health issue. The optimal methodology for validating real clinically significant IgE-mediated penicillin allergy should employ only commercially available materials, be well tolerated and simple to conduct in both inpatient and outpatient settings, and reduce false-positive findings. This review focuses on publications published in 2013 and 2014 that offer new information about the diagnosis and treatment of penicillin allergy. Penicillin allergy can be evaluated safely at this time in patients with an appropriate clinical history of penicillin allergy, using only penicilloyl-poly-lysine and native penicillin G as skin test reagents, if all skin test negative individuals are given an oral challenge with amoxicillin 250 mg, followed by 1 hour of observation.
Millions of people who have been wrongly diagnosed with penicillin allergy must be assessed in order for them to be able to utilise penicillin-class medicines safely and avoid the morbidity associated with penicillin avoidance. More research is required to find the best procedure (s). Even with optimum methods for determining acute penicillin tolerance, there will still be a 1–2% incidence of adverse events recorded with all future therapeutic penicillin-class antibiotic usage. Only a tiny percentage of these new responses will be mediated by IgE.
