Background: Penicillin allergy is one of the most commonly reported drug allergies, with an estimated 10% of the general population claiming to be allergic. However, the true prevalence of penicillin allergy, based on IgE-mediated hypersensitivity, is much lower, at approximately 1-3%. Misdiagnosis of penicillin allergy can result in the unnecessary use of alternative antibiotics, contributing to increased healthcare costs, adverse effects, and antibiotic resistance. This review explores the current approaches to the diagnosis and management of penicillin allergy.
Objective: To provide an overview of the diagnostic methods and management strategies for penicillin allergy, focusing on recent advances, diagnostic accuracy, and the safe reintroduction of penicillin in patients with a reported allergy.
Methods: A systematic review of studies published between 2010 and 2024 was conducted using electronic databases such as PubMed, Embase, and the Cochrane Library. Relevant articles were selected based on inclusion criteria including studies on diagnostic methods (skin testing, drug provocation testing, serological testing) and management strategies (penicillin desensitization, reevaluation of penicillin allergy).
Results: Penicillin allergy diagnosis primarily involves clinical history taking, skin testing, and drug provocation testing (DPT). Skin testing is considered the gold standard for diagnosing IgE-mediated reactions, while DPT is the definitive method for confirming tolerance in patients with uncertain allergy histories. Penicillin desensitization is an effective strategy for patients with a confirmed allergy who require penicillin for treatment, particularly in high-risk cases. Reevaluation of penicillin allergy, particularly in patients with mild or unclear histories, is recommended to reduce unnecessary use of broad-spectrum antibiotics and improve patient outcomes.
Conclusions: Accurate diagnosis and management of penicillin allergy are critical for improving patient care and reducing the overuse of alternative antibiotics. Advances in diagnostic methods, particularly the use of drug provocation testing, and strategies such as penicillin desensitization, are improving clinical outcomes. Future efforts should focus on developing more efficient diagnostic tools and guidelines for the safe reintroduction of penicillin in allergic patients.

KEYWORDS: Penicillin allergy, diagnosis, management, skin testing, drug provocation testing, penicillin desensitization, antibiotic stewardship