Roland Solensky

Penicillin allergy as a public health measure.

Penicillin allergy is self-reported by approximately 10% of the population. Therefore physicians are often faced with having to choose antibiotic therapy for patients with a history of penicillin allergy. When surveyed physicians are presented theoretic scenarios of antibiotic treatment in patients with a history of penicillin allergy, it is not surprising that they frequently choose non–b-lactam antibiotics, such as quinolones, vancomycin, and macrolides. Studies of prescribing patterns in both hospital and clinic settings have shown that patients labeled as having ‘‘penicillin allergy’’ are more likely to be treated with broadspectrum antibiotics, such as quinolones, vancomycin, and third-generation cephalosporins. At a university hospital, Lee et al retrospectively analyzed computerized records and found that among inpatients with a history of penicillin allergy, 39.7% received vancomycin and 21.5% received levofloxacin compared with 17.4% and 8.0% of patients without any antibiotic allergies, respectively (P < .001 for each data pair). Similarly, at a university-based clinic, retrospective medical record review of patients whowere prescribed antibiotics for either an upper respiratory tract infection or urinary tract infection revealed that those with a b-lactam allergy were more likely to have received cephalosporins, macrolides, quinolones, tetracyclines, or nitrofurantoin (P 5 .001 for all antibiotics). Hospitals commonly restrict use of vancomycin to specific indications, one of which is ‘‘penicillin allergy.’’ Review of pharmacy records has shown that in 31% to 51% of all vancomycin prescriptions, the drug was prescribed instead of another antibiotic solely because of a recorded ‘‘penicillin allergy.’’ Use of broad-spectrum antibiotics is associated with various clinical complications, such as antibiotic resistance and Clostridium difficile. Using a retrospective case-control design, Martinez et al evaluated risk factors for acquisition of vancomycin-resistant enterococcus (VRE) in patients admitted to a medical intensive care unit, comparing them with matched control subjects. They found that during the previous month, patients with VRE were significantly more likely to have been treated with vancomycin (odds ratio, 5.1; P 5 .02), cephalosporins (mostly third generation; odds ratio, 6.0; P 5 .03), and

Resolution of fish allergy: a case report

BACKGROUND Fish allergy is one of the most common food allergies, and it is believed to be lifelong. There are no published reports, to my knowledge, of resolution of fish allergy. OBJECTIVE To report a case of resolution of IgE-mediated fish allergy. METHODS The patient was a 68-year-old man with a history of fish-induced anaphylaxis who had previously undergone prick-puncture skin testing to several fish species. Additional skin testing was performed in October 2002. Subsequently, he underwent an open challenge with halibut. RESULTS The patients previous skin tests showed him to have strongly positive reactions to several fish species. However, testing performed in October 2002 produced negative results to a number of fish species. In addition, he tolerated an open challenge with halibut. In the ensuing 8 months, he has regularly ingested salmon, cod, and halibut without experiencing any allergic reactions. CONCLUSIONS This case illustrates that fish allergy is not invariably lifelong. Hence, allergists should consider reevaluating the allergy status of adults with a history of fish hypersensitivity.

Evaluation of Antibiotic Allergy: the Role of Skin Tests and Drug Challenges

Antibiotic allergies are frequently reported in both adult and pediatric populations. While a detailed drug history is essential in the evaluation of antibiotic allergy, the history is typically insufficient to determine the presence of a drug allergy. The most readily available diagnostic testing for evaluating antibiotic allergies are drug skin testing and drug challenges. This review will focus on updates in the evaluation of antibiotic allergy utilizing immediate skin tests, delayed intradermal testing, drug patch tests, and drug challenges for both adults and children with histories of antibiotic allergies.