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.