Nature and extent of penicillin side-reactions, with particular reference to fatalities from anaphylactic shock

Bull World Health Organ. 1968;38(2):159-88.


PIP: An appraisal is made of toxic, microbiogenic, and allergic side effects occurring in man as a result of large amounts of penicillin increasingly used in medical and veterinary practice. The allergic reactions constitute the most common and significant side effects of penicillin. The major antigenic determinant in penicillin allergy, the penicilloyl group derived from the penicillanic acid nucleus, is common to all penicillins and explains, at least in part, the cross-reactivity of man to any penicillin derivative or preparation. Available data do not permit conclusions as to the true frequency of allergic reactions to penicillin which are reported to vary from 0.7-10% in different studies in different countries. Among the side effects, the anaphylactic type may occur in about 0.015-0.004% with a fatality rate from shock of 0.0015-0.002% among treated patients. There is no convincing evidence that the frequency of allergic side effects to penicillin has increased in the last 10 years in relation to the increasing, worldwide use of penicillin. Persons in contact with penicillin may respond by producing antibodies, the presence of which can be determined by immunological procedures, and these are believed to be partly responsible for sudden penicillin side reactions. Routine prospective skin testing prior to penicillin administration cannot, however, be generally advocated at present but, in special instances, it can be undertaken in cooperation with specialists and competent laboratories. The present investigation includes a study of 151 anaphylactic fatalities reported to have followed penicillin administration. Of these persons, 14% had evidence of previous allergies of some kind, 70% had received penicillin previously, and 1/3 of these had already experienced prior sudden allergic reactions. In most of these fatal cases, the symptoms leading to death occurred within 15 minutes. An Expert Committee of the World Health Organization has emphasized that most anaphylactic fatalities can be prevented by measures to reduce penicillin sensitization environmentally in the population on the 1 hand, and by the preparedness of doctors on the other. (author's modified)

MeSH terms

  • Anaphylaxis / mortality*
  • Anaphylaxis / therapy
  • Drug Hypersensitivity / epidemiology
  • Drug Hypersensitivity / prevention & control
  • Humans
  • Penicillins / adverse effects*
  • Skin Tests


  • Penicillins