The first is a CME review authored by Eric Macy, MD, MS, FACAAI, and David Vyles, DO, MS, that examines the evidence of who really needs penicillin testing. We have all had patients who were told they had a penicillin allergy as a child because of a headache or episode of diarrhea days into therapy versus a patient with a history of receiving a dose of penicillin (or derivative) and 15 minutes later breaking out in hives followed by dizziness and dyspnea. Those two extremes are fairly straightforward in their evaluation and management. But what about a less clear history? This article provides excellent rationale and recommendations on who should be tested, the extent of the testing including use of minor determinants and oral challenge and therapeutic directions based upon the results of testing or challenge.
Another interesting and useful article is by N. Franklin Adkinson Jr., MD, Louis Mendelson, MD, FACAAI, and colleagues who review penicillin minor determinants. We all know that the term “minor” can be misleading in terms of importance in reaction severity of sensitive patients. The authors make an evidence-based case for the use of minor determinants in comprehensive penicillin testing for high-suspicion penicillin allergic patients and, in particular, the negative predictive value of the procedure.
The perspectives of these two articles are distinct but both are evidence-based. Accordingly, each reader can use these two highly evidence-based articles to evaluate their own attitudes and practices in approach to the putative penicillin allergic patient. This will be a topic of conversation at our upcoming Annual Meeting and beyond. See you in Seattle!
Gailen D. Marshall Jr., MD, PhD, FACAAI
Editor-in-chief