Matthieu Picard1, Louis Paradis1, Philippe Bégin1, Jean Paradis2, Anne Des Roches3. 1. Division of Allergy, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. 2. Division of Allergy, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. 3. Division of Allergy, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. Electronic address: a.des.roches@umontreal.ca.
Abstract
BACKGROUND: The absence of commercially available penicilloyl-polylysine (PPL) for most of the last decade severely hampered the practice of penicillin allergy evaluation because skin testing without PPL is reported to have a poor negative predictive value (NPV). OBJECTIVE: To determine the safety and NPV of skin testing without PPL using only penicillin G followed by a 3-dose graded challenge to the incriminated penicillin in children with a history of penicillin allergy. METHODS: Patients evaluated for a history of penicillin allergy at the CHU Sainte-Justine Allergy Clinic between December 2006 and December 2009 were skin tested only with penicillin G and underwent a 3-dose graded challenge to the culprit penicillin if the skin test result was negative. RESULTS: Among 563 patients skin tested to penicillin G, 185 (33%) had a positive skin test result. These patients had a shorter interval between the initial reaction and skin testing compared with patients with a negative skin test result (P = .03). A total of 375 of 378 patients (99%) with a negative skin test result were challenged and 18 (4.8%) reacted, translating into a NPV of 95.2% (95% confidence interval [CI], 92.5%-97.1%). Three of 17 patients with a history of anaphylaxis and a negative skin test result reacted to challenge (NPV, 82.4%; 95% CI, 59.0-93.8%). All challenge reactions were mild and resolved promptly with treatment. CONCLUSION: Among children with a history of penicillin allergy, skin testing only with penicillin G followed by a 3-dose graded challenge to the incriminated penicillin is safe and yields a good NPV. This approach could be useful when PPL is unavailable.
BACKGROUND: The absence of commercially available penicilloyl-polylysine (PPL) for most of the last decade severely hampered the practice of penicillinallergy evaluation because skin testing without PPL is reported to have a poor negative predictive value (NPV). OBJECTIVE: To determine the safety and NPV of skin testing without PPL using only penicillin G followed by a 3-dose graded challenge to the incriminated penicillin in children with a history of penicillinallergy. METHODS:Patients evaluated for a history of penicillinallergy at the CHU Sainte-Justine Allergy Clinic between December 2006 and December 2009 were skin tested only with penicillin G and underwent a 3-dose graded challenge to the culprit penicillin if the skin test result was negative. RESULTS: Among 563 patients skin tested to penicillin G, 185 (33%) had a positive skin test result. These patients had a shorter interval between the initial reaction and skin testing compared with patients with a negative skin test result (P = .03). A total of 375 of 378 patients (99%) with a negative skin test result were challenged and 18 (4.8%) reacted, translating into a NPV of 95.2% (95% confidence interval [CI], 92.5%-97.1%). Three of 17 patients with a history of anaphylaxis and a negative skin test result reacted to challenge (NPV, 82.4%; 95% CI, 59.0-93.8%). All challenge reactions were mild and resolved promptly with treatment. CONCLUSION: Among children with a history of penicillinallergy, skin testing only with penicillin G followed by a 3-dose graded challenge to the incriminated penicillin is safe and yields a good NPV. This approach could be useful when PPL is unavailable.
Authors: David Vyles; James W Antoon; Allison Norton; Cosby A Stone; Jason Trubiano; Alexandra Radowicz; Elizabeth J Phillips Journal: Ann Allergy Asthma Immunol Date: 2020-03-26 Impact factor: 6.347