History of PCN allergic reaction |
If there is no good suggestive history for PCN allergy, or the history of the reaction is remote, we advise to give the PCN (or its derivatives). |
If the history is suggestive for non-anaphylactic reaction to PCN we recommend to perform the commercially available PCN skin test: ・ If the test is negative, give the PCN. ・ If the test is positive perform graded challenge (see below). |
If the history is suggestive for non-anaphylactic DHR and PCN skin test is not available, we would also recommend performing PCN graded challenge. |
If the history is confirmative for anaphylaxis, an alternative drug is recommended. If the PCN is absolute, then performing PCN desensitization is recommended (see below). |
Graded challenge (also called provocation challenge): give 1/1000th to 1/10th of the therapeutic dose in a 30 minutes’ interval till reach the recommended dose. Desensitization refers to a process of giving a medication in a controlled and gradual manner, which allows the person to tolerate it temporarily without an allergic reaction. Several protocols are available for certain medications. |