Beta-lactam oral desensitization protocol

Beta-lactam concentration (mg/mL)*	Dose number^¶	Amount given^Δ (mL)	Dose given during step (mg)	Cumulative dose (mg)^[1]
0.5	1	0.1	0.05	0.05
	2	0.2	0.10	0.15
	3	0.4	0.20	0.35
	4	0.8	0.40	0.75
	5	1.6	0.80	1.55
	6	3.2	1.60	3.15
	7	6.4	3.20	6.35
5	8	1.2	6	12.35
	9	2.4	12	24.35
	10	4.8	24	49.35
50	11	1	50	100
	12	2	100	200
	13	4	200	400
	14	8	400	800

Upon completion of the steps above, observe patient for 30 minutes. Additional therapeutic doses can then be given by the route of choice, at normal dosing intervals.

* Dilutions prepared from antibiotic syrup, 250 mg/5 mL.
¶ Dose approximately doubled every 15 minutes.
Δ Drug amount given in 30 mL water or flavored beverage.

Reference:

Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol 2010; 105:259.

Original figure modified for this publication. Sullivan TJ. Drug allergy. In: Allergy: Principles and Practice, 4th Edition, Middleton EJ, Reed CE, Eliss EF, et al (Eds), St. Louis: Mosby, 1993. Table used with the permission of Elsevier Inc. All rights reserved.

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Beta-lactam oral desensitization protocol