Three cases of fatal anaphylaxis to antibiotics in patients with prior histories of allergy to the drug

Since penicillin and cephalosporin antibiotics have come into common use many deaths have been reported from anaphylaxis following their administration. 1-5 Since the 1960s there have been extensive efforts made to educate physicians to the existence and dangers of allergic reactions to these antibiotics. A number of well tested protocols have been published for administering these antibiotics to the allergic patient when other drugs cannot be substituted.6,7 Some reactions to penicillin and cephalosporin antibiotics are known to be mediated by IgE antibodies.4,8,9 These include anaphylactic and urticarial reactions while other reactions to betalactam antibiotics such as serum sickness, hemolytic anemia, maculopapular rashes, and Stevens-Johnson syndrome are not IgE mediated. The population at risk for anaphylactic reactivity to beta-lactam antibiotics can be identified by testing patients with a prior history of adverse reactions. Skin testing with