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Oral Desensitization for Penicillin Sensitivity

Barbara J. Stark, MD; George D. Wendel, MD; Timothy J. Sullivan, MD
JAMA. 1987;257(11):1474. doi:10.1001/jama.1987.03390110050020.
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To the Editor.—  In the recent report of a successful parenteral desensitization of a pregnant, penicillin-allergic woman with syphilis, Ziaya and colleagues1 proposed that parenteral desensitization is preferable to the more widely studied oral desensitization method.2-4 Fatal and near-fatal anaphylactic reactions during parenteral desensitization are well documented2 and should have been considered more carefully.Four important considerations suggest that oral desensitization is safer. First, deaths from orally administered penicillins are exceedingly rare.2 In one large study, all of 72 fatal anaphylactic reactions to penicillin were induced by parenteral therapy,5 despite the more prevalent use of oral therapy. Second, the drug polymers and penicillin-mold protein conjugates that contaminate therapeutic materials, thought to be important elicitors of anaphylaxis,6 would not be expected to be absorbed after oral administration. Third, blood levels gradually rise after oral administration, favoring univalent (harmless) conjugation, in contrast to the locally very

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