Since 1973 penicillamine has been used with increased frequency in the management of rheumatoid arthritis (RA) (1,2). Frequent toxic complications, often leading to discontinuation, are the most critical problem when using this drug (3). Also of concern, but not previously critically evaluated, is its use in penicillin-allergic individuals.
Penicillamine is a product of the metabolism of penicillin, and several studies have demonstrated positive penicillamine skin test crossreactivity in penicillin-allergic individuals (4-6). This information suggests a potential risk of anaphylaxis if penicillamine is administered to penicillin-allergic individuals with rheumatoid arthritis. This concern is not shared by all, however. There are physicians who believe clinical experience with the drug has demonstrated that allergy to penicillin is not a contraindication to penicillamine use (7). Since crossreactivity between the two drugs is documented, it is difficult to evaluate from clinical experience alone the extent of the risk of severe reaction.
The following study was designed to evaluate
Presented in part at the 451h Annual Meeting of the American Rheumatism Association,