ALLERGY TO BETA-LACTAMS - A SURVEY OF CURRENT PRACTICES

Many issues related to the diagnosis and management of beta-lactam dru g allergy still await definitive recommendations. To determine how pra cticing allergists deal with some of these dilemmas, a questionnaire w as mailed to 3500 physician members and fellows of the American Academ y of Allergy and Immunology. It was also sent to each of the allergy t raining program directors in the United States to determine what is cu rrently taught to fellows in training. Benzylpenicilloyl-polylysine (P re-Pen) and fresh penicillin G are used for skin testing by more than 86% of both respondent groups, whereas minor determinant mixtures are used by only 40%. Epicutaneous followed by intradermal injection was t he skin test technique used by 86% of these allergists. More than 90% said they would skin test in cases of reaction history of urticaria, w hereas only 1.5% would test in cases of family history of penicillin a llergy. Practicing allergists and program directors differed slightly when queried about cephalosporin cross-reactivity. Program directors w ere more cautious in their use of cephalosporins with patients allergi c to penicillin. Program directors were also more likely to repeat ski rt testing before future penicillin courses than were practicing aller gists. Clearly, some individual approaches to the diagnosis and manage ment of beta-lactam allergy are practiced. Development of practice gui delines by our professional organizations may be useful.