Original Articles: Mechanisms of Allergic and Immune DiseasesFemale sex as a risk factor for 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
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Authors have nothing to disclose.