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Lack of Penicillin Resensitization in Patients With a History of Penicillin Allergy After Receiving Repeated Penicillin Courses
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.
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