Amoxicillin Allergy: Old Concepts, New Concepts and Change of Concepts
DOI:
https://doi.org/10.58931/cait.2021.1219Abstract
More than one million Canadian children are treated annually with antibiotics, mainly amoxicillin.1-4 Up to 10% of children develop rashes while treated with amoxicillin.1-5 The majority of children presenting with rashes during amoxicillin treatment are diagnosed with amoxicillin hypersensitivity without further evaluation and often carry this diagnosis into adulthood. There remains controversy in the medical literature regarding the most accurate and safe strategy for diagnosing amoxicillin hypersensitivity. As a result, most children continue to avoid amoxicillin and other penicillin derivatives throughout life in favor of alternatives that are reported to be less effective, more toxic, and more expensive. There is much we do not know about the pathogenesis of amoxicillin hypersensitivity. Consequently, the appropriate diagnostic strategy required to establish the presence of true amoxicillin hypersensitivity is unclear. In order to develop an appropriate diagnostic approach, it is important to understand the pathogenic mechanisms accounting for amoxicillin hypersensitivity and the validity of the available confirmatory tests. This review will discuss the pathogenic mechanisms underlying amoxicillin allergy, describe the challenges in the diagnosis of amoxicillin allergy, critically assess the role of skin testing and IgE levels and discuss the appropriate diagnostic strategy in individuals presenting with suspected amoxicillin allergy.
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