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Introduction: The incidence of allergy to penicillin is highly overestimated. Many patients are labeled as penicillin-allergic, which is often unconfirmed. We report an analysis of patients that were referred for evaluation of suspected penicillin allergy in 2007 and 2008., Methods: In a 2-year period, 606 patients were referred: 460 (76%) female, average age 42 (14-85) years. The diagnostic procedure started with specific IgE (sIgE) measurement, followed by skin prick and intradermal tests with PPL, MDM, and the suspected antibiotic. If all tests were negative, a drug provocation test was performed (DPT). If more than 3 years had passed from the reaction and if the reaction was not severe, the DPT followed serological tests., Results: In 49 (8%) patients, sIgE to penicillin was detected. Skin testing was performed on 274 (45%) sIgE-negative patients, with positive results in 14 (5%) patients. In 426 (70%) patients, DPT with the suspected drug was performed, which was positive in 19 (4.5%) patients. Diagnosis of penicillin allergy was established in 82 (13.5%) patients., Conclusions: Tests of immediate hypersensitivity to penicillins were positive in a minority of patients referred. It is important to confirm or exclude suspected allergy to antibiotics because unnecessary use of more expensive broad-spectrum agents also contributes to the development and spread of certain types of drug-resistant bacteria.

Background: Although immunotherapy is effective in allergic rhinitis, conjunctivitis, asthma and stinging insect hypersensitivity, it carries a risk of anaphylactic reactions., Methods: In a 4-year retrospective survey, we investigated 1257 adult patients who had received venom or inhaled-allergen subcutaneous immunotherapy. The dose-increase phase was performed as the 2-day rush protocol for venom immunotherapy and the 6-week protocol for inhaled-allergen immunotherapy., Results: A total of 904 patients received venom immunotherapy and 353 patients inhaled-allergen immunotherapy. The prevalence of systemic reactions was 13.6%. The frequency of systemic reactions was higher during the maintenance phase than in the dose-increase phase (9.6% vs. 5.9%) and was highest in both phases of treatment with honeybee venom (P < 0.001). The majority of systemic reactions were mild. Five (0.4%) patients had reaction with a fall of blood pressure and were treated with adrenaline. There was no fatal outcome. The systemic side-effects during the dose-increase phase of venom immunotherapy occurred at a median dose of 46 microg (range 2-100 microg). Large local reactions occurred in 13.9% of patients without any significant difference between the allergens., Conclusions: We have shown that systemic reactions are not rare even during maintenance phase in patients with a well tolerated dose-increase phase of treatment. The most prominent risk factor for systemic reactions was immunotherapy with honeybee extract.