This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (42)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Social Bookmarking   What's this?

Roland Solensky, MD; Harry S. Earl, MD; Rebecca S. Gruchalla, MD, PhD

Arch Intern Med. 2002;162:822-826.

Background  Up to 10% of the population reports an allergy to penicillin, yet more than 80% of these individuals lack penicillin-specific IgE antibodies. A negative result on a penicillin skin test is highly accurate in identifying who can safely receive the antibiotic at the time of testing. However, its negative predictive value for future courses is unknown because it is uncertain whether patients with a history of penicillin allergy are at risk of becoming resensitized.

Objective  To determine the rate of penicillin resensitization in adult patients with a history of penicillin allergy after they are challenged with repeated courses of oral penicillin.

Methods  Adult patients with a history of penicillin allergy consistent with an IgE-mediated mechanism were recruited and underwent penicillin skin testing. Those with negative skin test results were challenged with 3 successive 10-day courses of penicillin V potassium (250 mg by mouth 3 times a day), providing their penicillin skin test results remained negative prior to each course. Patients with positive skin test results were not challenged.

Results  Of 53 patients with initially negative skin test results, 46 completed the protocol, and each tolerated all 3 courses of penicillin with negative skin test results throughout. No patients had a converted skin test result from negative to a positive, yielding a resensitization rate of 0% (upper 95% confidence interval, 2.1%).

Conclusions  Adult patients with a history of penicillin allergy are not at increased risk of resensitization after receiving 3 courses of oral penicillin. Because a negative penicillin skin test result is predictive for subsequent oral administrations beyond the time of testing, adult patients with a history of penicillin allergy can be skin tested electively, which may avoid unnecessary treatment with alternate broad-spectrum antibiotics.

From the Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2002;162(7):847-848.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Preoperative Evaluation of Patients With History of Allergy to Penicillin: Comparison of 2 Models of Practice
Frigas et al.
Mayo Clin Proc. 2008;83:651-657.
ABSTRACT | FULL TEXT  

A Negative Skin Test Can Exclude Penicillin Resensitization
JWatch Infect. Diseases 2002;2002:5-5.
FULL TEXT