This document discusses penicillin allergy and its management. It covers: 1. The different types of penicillin antibiotics and their mechanisms of action. 2. The classification, symptoms, and treatment of different types of hypersensitivity reactions including penicillin allergy. 3. Guidelines for managing patients with a history of penicillin allergy undergoing dental procedures, including consulting an allergist, using alternative antibiotics or anesthetics, or general anesthesia.

2. • Penicillin is one of the most commonly
prescribed antibiotics. It is part of a
family of antibiotics known as beta
lactams, and there are many individual
medications

3. 1- Natural Penicillins e.g. Penicillin G
These have greatest activity against G+
organisms, g – cocci.

4. 2- Penicillinase-resistant Penicillins
( antistaphylococal P ) e.g. Cloxacillin,
Dicloxacillin, Methicillin, Nafcillin, Oxacillin.
They are active against staphylococci and
streptococci.

5. 3- Extended-spectrum P
e.g. Amoxicillin, ampicillin,
Have further activity against G- organism

6. • is a hypersensitive state acquired
through exposure to a particular
allergen.
• An immunologically mediated disease
• Covers broad range of clinical
manifestations from mild ,delayed
reaction to immediate life threatening
reactions

7. Four types:
Type I HSR : anaphylactic or IgE - mediated
Type II HSR : antibodies-mediated
Type III HSR : immune complex-mediated
Type IV: Cell-mediated (T-cells) or delayed

8. 1-Immunoglobulin(Ig)E antibody-mediated
2-Immediate response
3-allergens(antigens)
A. Dust
B. Mites
C. Pollens
D. Animal danders
E. Food
F. Drugs

9. 4-Symptomes
A. Anaphylaxis
B. Hay fever
C. Asthma
D. Urticaria , angioedema
E. Symptoms on occasion
5-Frequency:affect about 10% of population
6-Iherited tendency

10. • Penicillin allergy is an abnormal reaction of
your immune system to the antibiotic drug
penicillin
• A penicillin allergy is an allergic reaction that
occurs when your body's immune system
overreacts to penicillin antibiotic

11. Skin rashes
Hives itching
Shortness of
breath
wheezing
swelling
anaphylaxis
Itchy ,watery
eyes
Runny nose
fever

13. • Anaphylaxis is a rare, life-threatening allergic
reaction that causes the widespread
dysfunction of body systems. Signs and
symptoms of anaphylaxis include:

14. 1. Itching of soft palate
2. Nausea , vomiting
3. Sub sternal pressure
4. Shortness of breath
5. Hypotension
6. Urticaria
7. Laryngeal edema
8. Bronchospasm
9. Cardiac arrhythmias

15. • Serum sickness
• Drug induced anemia
• Drug reaction with eosinophilia and systemic
symptoms (DRESS)
• Inflammation in the kidneys (nephritis)

16. 1. A history of other allergies, such as food allergy
or hay fever
2. Allergic reaction to another drug
3. A family history of drug allergy
4. Increased exposure to penicillin, because of
high doses, repetitive use or prolonged use
5. Certain illnesses commonly associated with
allergic drug reactions, such as infection with
HIV or the Epstein-Barr virus

17. • Skin tests
• With a skin test, the allergist or nurse
administers a small amount of the suspect
penicillin to your skin either with a tiny needle
that scratches the skin or an injection. A positive
reaction to a test will cause a red, itchy, raised
bump.
• A positive result indicates a high likelihood of
penicillin allergy. A negative test result usually
means you're not allergic to penicillin, but a
negative result is more difficult to interpret
because some kinds of drug reactions cannot be
detected by skin tests

19. I. Treatment for the present allergy
symptoms
II. Desensitization to penicillin

20. 1-Treating current symptoms
• Withdrawal of the drug.
• Antihistamines.
• Corticosteroids.
• Treatment of anaphylaxis
2-Drug desensitization

22. 1. Inform health care workers
2. Wear a bracelet
3. Have an emergency kit

24. • Urticarial swelling or angioedema
• Reaction is rapid lesion developing within
short time
• Painless soft tissue swelling may cause
itching and burning
• Lesion can be present for 1-3 days if untreated
but will resolve spontaneously
• Oral antihistamine(oral diphenhydramine) 50
mg/4hrs for (1-3days)

25. 1. Urticaria or angioedema
A. Reaction occur soon after contact with
antigen
B. Reaction consist of painless swelling
C. Itching and burning may occur
D. Lesion may remain for 1-3 days

26. 1. Reaction not involving tongue , pharynx or
larynx and with no respiratory distress
noted requires 50 mg of diphenyhydramine
4 times a day until swelling diminshes
2. Reaction involving tongue , pharynx or
larynx with respiratory distress noted
requires the following:

27. A. 0.5ml of 1:1000 epinephrine , IM or SC
B. Oxygen
C. Once immediate danger is over,50 mg of
diphenhydramine should be given 4 times a
day until swelling diminishes

28. 1. Call for medical help
2. Place patient in supine position
3. Check for open airway
4. Administer oxygen

29. 5-Check pulse , blood pressure and respiration.
• If any of vital signs is depressed or absent
inject o.5ml 1:1000 epinephrine into tongue
• Provide cardiopulmonary resuscitation if
needed
• Repeat IM injection of 0.5 ml 1:1000
epinephrine if no response

31. I. Tetracycline (e.g. doxycycline)
II. quinolones (e.g. ciprofloxacin)
III. macrolides (e.g. clarithromycin)
IV. aminoglycosides (e.g. gentamicin)
V. glycopeptides (e.g. vancomycin)

32. 1. Erythromycin or clindamycin for treatment
of oral infection
2. Or clindamycin for prophylaxis against
infective endocarditis
• Don’t use aspirin

33. • Patient with history of penicillin reaction :1st
skin test for penicillin sensitivity
A. Negative –use penicillin or cephalosporin
B. Positive:
1. Avoid penicillin
2. Skin test for cephalosporin ;use it if result is
negative

34. • ELECTIVE DENTAL CARE:
• Elective dental case requiring local
anasthesia may need to be postponded
until a thorough evaluation of the
patient is completed by a competent
individual

35. • Option 1: consultation
• Immediate consultation to test the patient
for allergy to LA.
• If pain is present it may be managed orally
with various analgesics and infections can be
controlled with antibiotics

36. • Option2:General anasthesia
• Use of GA in place of LA to manage the
dental emergency.
• Highly useful and relatively safe technique
but has complications and unavailability in
dental office

37. Option 3:Histamine Blocker
1. Use of histamine blocker like diphenhydramine as
LA.
2. 1%solution with 1 in 100,000 epinephrine,pulpal
anasthesia upto 30 mins is produced
3. Burning or stinging sensation is produced which
can be minimized by using nitrous oxide and O2
4. Post operative tissue swelling and soreness
maybe present

38. Appropriate drug therapy with
immediate medical
consultation(option 1)is the most
reasonable mode of action

39. 1. Dentist should obtain from each patient a
history of any reaction
2. Avoid contact with or use of antigens
3. Most of allergic patient can receive any
dental treatment as long as the antigen is
avoided and precautions are taken for
patient receiving steroids or have
angioedema