Original Articles: Mechanisms of Allergic and Immune Diseases
Female sex as a risk factor for penicillin allergy

https://doi.org/10.1016/S1081-1206(10)60621-7Get rights and content

Background

Identification of risk factors is an integral part of a physician's evaluation of a patient.

Objective

To determine whether female sex is an independent risk factor for penicillin allergy.

Methods

Rates of positive penicillin skin test (PST) results, according to sex, were determined in patients with a history of penicillin allergy undergoing penicillin allergy evaluation with major and minor determinants of penicillin between June 1, 2002, and June 30, 2004. Univariate and multivariate logistic regression analyses were used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for sex differences in the rates of positive PST results.

Results

Of the 1,921 patients, 1,759 underwent PST and 157 did not; 5 medical records were not available for review. The mean patient age was 60 years. Sixty-four patients (4%) had a positive PST reaction; of these, 53 (83%) were females and 11 (17%) were males (OR, 3.6; 95% CI, 1.9–7.2; P < .001). In a multivariate logistic regression analysis adjusted for age, history of multiple drug allergies, and elapsed time from the initial penicillin adverse drug reaction to PST, female sex again had a significant risk of a positive PST reaction (OR, 3.2; 95% CI, 1.6–6.7; P = .001).

Conclusion

A greater risk of penicillin allergy exists in association with female sex in patients with a history of penicillin allergy.

Section snippets

INTRODUCTION

The incidence of self-reported penicillin allergy ranges from 1% to 10%,1, 2 with the frequency of life-threatening anaphylaxis estimated to be 0.01% to 0.05%.3 The patient's history is a poor predictor of penicillin allergy4, 5 compared with the penicillin skin test (PST) result. A patient with a negative PST reaction to the major and minor determinants of penicillin and a history of penicillin allergy is at low risk for an immediate-type hypersensitivity reaction to penicillin (1%–3%).6, 7, 8

Patients

At our institution, patients undergo a preoperative medical examination at the preoperative evaluation (POE) clinic the day before their elective surgery. We developed a clinical pathway identifying patients with a self-reported penicillin allergy in the POE clinic. These patients are evaluated by an allergist and undergo PST at the POE clinic the same day. These consecutive patients with a history of penicillin allergy seen between June 1, 2002, and June 30, 2004, at the POE clinic for an

RESULTS

Between June 1, 2002, and June 30, 2004, 19,429 patients were seen in the POE clinic, of which 1,921 (10%) had a history of penicillin allergy and compose the study population. The overall mean ± SD age of the study group was 60 ± 15 years (55 ± 17 years in the positive PST result cohort; 60 ± 15 years in the negative PST result cohort). Of the 1,921 patients, 1,759 underwent skin testing for penicillin and 157 did not; 5 medical records were not available for review. Sixty-four of 1,759

DISCUSSION

We describe the first study demonstrating a 3.6-fold greater risk of a positive PST result exists in association with female sex in patients with a reported history of penicillin allergy. The size of the wheal and flare in the PST defining a positive PST result did not affect the increased risk of penicillin allergy in females. However, when a wheal and flare size in the PST greater than 5 × 5 mm is considered a positive PST reaction, female sex as a risk factor for penicillin allergy is no

REFERENCES (25)

  • JR Kerr

    Penicillin allergy: a study of incidence as reported by patients

    Br J Clin Pract

    (1994)
  • S Ahlstedt

    Penicillin allergy: can the incidence be reduced?

    Allergy

    (1984)
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