Eric Macy1, Eunis W Ngor2. 1. Department of Allergy, Southern California Permanente Medical Group, San Diego Medical Center, San Diego, Calif. Electronic address: eric.m.macy@kp.org. 2. Department of Research and Evaluation, Kaiser Permanente Health Care Program, Pasadena, Calif.
Abstract
BACKGROUND: Penicillin skin testing is rarely used to undiagnose penicillin "allergy" in the United States, partially because of concern that commercially available materials are inadequate. OBJECTIVE: We determined whether skin testing with only commercially available penicilloyl-poly-lysine and penicillin followed by an oral amoxicillin challenge, if skin test-negative, can safely identify clinically significant penicillin allergy. METHODS: Five hundred sequential persons with positive history of penicillin "allergy" were evaluated by skin testing with penicilloyl-poly-lysine and penicillin between June 8, 2010, and March 29, 2012. All persons with negative skin tests were given an oral amoxicillin challenge and observed for 1 hour. RESULTS: Persons undergoing penicillin allergy testing were representative of all health plan members with penicillin allergy. Only 4 persons (0.8%; 95% CI, 0.32%-2.03%) had a positive skin test result. Only 4 persons (0.8%; 95% CI, 0.32%-2.03%) had an acute objective oral amoxicillin challenge reaction. Fifteen persons (3.0%; 95% CI, 1.83%-4.98%) had subjective oral challenge reactions, either acute transient itching or dizziness. All were women and 11 (73.3%) had multiple drug intolerance syndrome. None had severe reactions or objective signs. These were not considered to be positive challenge reactions. Sixty-eight subjects (13.6%) who were negative on testing were exposed to 88 courses of penicillins during 90 days of follow-up. New reactions were reported after 4 courses (4.5%), 3 (75%) occurring in subjects with multiple drug intolerance syndrome. CONCLUSIONS: Penicillin skin testing, using only penicilloyl-poly-lysine and penicillin, followed by oral amoxicillin challenge, if negative, can safely identify clinically significant IgE-mediated penicillin allergy in patients who use health care in the United States at this time.
BACKGROUND:Penicillin skin testing is rarely used to undiagnose penicillin "allergy" in the United States, partially because of concern that commercially available materials are inadequate. OBJECTIVE: We determined whether skin testing with only commercially available penicilloyl-poly-lysine and penicillin followed by an oral amoxicillin challenge, if skin test-negative, can safely identify clinically significant penicillinallergy. METHODS: Five hundred sequential persons with positive history of penicillin "allergy" were evaluated by skin testing with penicilloyl-poly-lysine and penicillin between June 8, 2010, and March 29, 2012. All persons with negative skin tests were given an oral amoxicillin challenge and observed for 1 hour. RESULTS:Persons undergoing penicillinallergy testing were representative of all health plan members with penicillinallergy. Only 4 persons (0.8%; 95% CI, 0.32%-2.03%) had a positive skin test result. Only 4 persons (0.8%; 95% CI, 0.32%-2.03%) had an acute objective oral amoxicillin challenge reaction. Fifteen persons (3.0%; 95% CI, 1.83%-4.98%) had subjective oral challenge reactions, either acute transient itching or dizziness. All were women and 11 (73.3%) had multiple drug intolerance syndrome. None had severe reactions or objective signs. These were not considered to be positive challenge reactions. Sixty-eight subjects (13.6%) who were negative on testing were exposed to 88 courses of penicillins during 90 days of follow-up. New reactions were reported after 4 courses (4.5%), 3 (75%) occurring in subjects with multiple drug intolerance syndrome. CONCLUSIONS:Penicillin skin testing, using only penicilloyl-poly-lysine and penicillin, followed by oral amoxicillin challenge, if negative, can safely identify clinically significant IgE-mediated penicillinallergy in patients who use health care in the United States at this time.
Authors: Anca M Chiriac; Aleena Banerji; Rebecca S Gruchalla; Bernard Y H Thong; Paige Wickner; Paul-Michel Mertes; Ingrid Terreehorst; Kimberly G Blumenthal Journal: J Allergy Clin Immunol Pract Date: 2018-12-17
Authors: Martin H Thornhill; Mark J Dayer; Bernard Prendergast; Larry M Baddour; Simon Jones; Peter B Lockhart Journal: J Antimicrob Chemother Date: 2015-04-29 Impact factor: 5.790
Authors: Kimberly G Blumenthal; Ilan Youngster; Erica S Shenoy; Aleena Banerji; Sandra B Nelson Journal: Antimicrob Agents Chemother Date: 2014-03-17 Impact factor: 5.191
Authors: Kimberly G Blumenthal; Erin E Ryan; Yu Li; Hang Lee; James L Kuhlen; Erica S Shenoy Journal: Clin Infect Dis Date: 2018-01-18 Impact factor: 9.079