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Skin testing only with penicillin G found safe, effective in children with penicillin allergy history
Skin testing using only penicillin G and followed by a three-dose graded challenge was safe in children with a history of penicillin allergy and provided a good negative predictive value (NPV), according to study results.
“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,” researchers in Montreal reported.
The researchers conducted skin testing using only penicillin G in 563 patients with a history of penicillin allergy between December 2006 and December 2009 at the CHU Sainte-Justine Allergy Clinic. A graded challenge (one-one hundreth of a therapeutic dose, followed by one-tenth and then full dose) to the culprit penicillin was conducted if there was a negative skin test result.
One hundred eighty-five (33%) patients tested positive, with a shorter interval between initial reaction and skin testing compared with patients with negative results (P=.03). The challenge was conducted on 375 patients (99%) with a negative skin test result, and 18 patients (4.8%) reacted (NPV=95.2%; 95% CI, 92.5%-97.1%). Seventeen patients had a history of anaphylaxis and negative skin test results, three of which showed a reaction (NPV=82.4%, 95% CI, 59%-93.8%).
Challenge reactions in patients were considered mild and resolved quickly after therapy.
“Although PPL in combination with penicillin G and/or other minor determinants remains the preferred skin test regimen, this study found that in the absence of PPL, penicillin allergy evaluation can be safely performed in children using only penicillin G followed by a graded drug challenge to the incriminated penicillin,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.