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  • Open Access

Quality of penicillin allergy management in the intensive care unit and internal medicine ward

  • 1, 2Email author,
  • 1, 2,
  • 1,
  • 1,
  • 1,
  • 2 and
  • 1
Allergy, Asthma & Clinical Immunology20106 (Suppl 2) :P1

  • Published:


  • Intensive Care Unit
  • Penicillin
  • Vancomycin
  • Skin Testing
  • Continuous Medical Education


Penicillin allergy is reported by 10% of the population [1]. The associated morbidity is substantial given its medical and economic implications [24]. The aim of this study was to assess the quality of care with regards to the management of penicillin allergy in a university affiliated general hospital with no allergy service.

Material and methods

All admissions from December 1st 2008 to December 1st 2009 were hand reviewed for a notion of penicillin allergy. Files were then assessed for (1) quality of allergic history to penicillin, (2) referral to an allergy clinic upon discharge, (3) indications for such a referral, (4) indication for a beta-lactam, and in the latter case, (5) management of antibiotic therapy.


Of the 1738 files reviewed, 172 contained a notion of alleged penicillin allergy. History of the reaction to penicillin was poorly detailed even when patients required beta-lactam therapy (table 1). In the 87 patients who did require a beta-lactam, half received it without any skin testing, challenge or desensitization. No adverse reaction occurred. The main antibiotics used in the remaining patients were fluoroquinolones and vancomycin. Decision-making concerning the choice of antibiotic was documented in only 18%. Upon discharge, only two patients were referred to an allergy clinic for elective penicillin skin testing, even though referral was strongly indicated in 97 patients (table 2).
Table 1

Details included in allergy history


All patients (n=172)

Patients with indication for beta-lactam (n=87)

Allergy to penicillin noted in admission note

139 (81%)

69 (79%)

Allergy tag on file

119 (69%)

66 (76%)

Molecule specified

31 (18%)

23 (26%)

Allergic reaction described

52 (30%)

27 (31%)

Delay since reaction noted

7 (4%)

5 (6%)

Treatment of allergic reaction noted



Table 2

Strong arguments for allergy referral.


Number of patient (n=172)

Allergy to a non beta-lactam antibiotic

37 (22%)

Immunosuppressive treatment

15 (9%)

Chronic disease (COPD, CKD on dialysis, complicated diabetes)

85 (49%)

Admitted for acute infection

72 (42%)

Planned surgery

49 (28%)


128 (74%)

Any and survived hospitalisation

97 (56%)


Penicillin allergy is a frequent problem in hospital practice. Its management is not optimal in most cases. This study stresses the importance of continuous medical education on this subject and the importance of a readily available inpatient allergy service to support hospital practitioners.

Authors’ Affiliations

Department of medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada, H1T 2M4
Department of medicine, Centre Hospitalier de l’Université de Montréal, Montreal, Canada, H2L 4M1


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© Bégin and Picard; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.