Oral antibiotic adverse reactions after penicillin skin testing: multi-year follow-up

Allergy. 2002 Dec;57(12):1151-8. doi: 10.1034/j.1398-9995.2002.23700.x.


Background: Long-term follow-up data on adverse drug reactions after oral antibiotic use in penicillin allergy history positive individuals with penicillin skin test done in advance of need are rare.

Methods: Oral antibiotic associated adverse drug reactions in 83 penicillin skin test positive individuals were compared to a sex, age, and length of follow-up matched sample of 166 penicillin skin test negative individuals, all of whom had at least one post penicillin skin test oral antibiotic. The mean post penicillin skin test follow-up interval was 34.5 +/- 16.6 months. There were 1655 total oral antibiotic exposures.

Results: In penicillin skin test positive individuals, the adverse drug reaction rate was not significantly different with cephalosporin or non-beta-lactam use (P = 0.12). In penicillin skin test negative individuals the adverse drug reaction rate was significantly lower with cephalosporin vs. non-beta-lactam use (P = 0.005). Penicillin was safely used in penicillin skin test negative individuals. Overall cephalosporins caused fewer adverse drug reactions independent of penicillin skin test status (P = 0.005).

Conclusions: Penicillin skin testing was only able to predict penicillin associated adverse drug reactions in penicillin skin test positive individuals. Excluding accidental penicillin exposure in penicillin skin test positive individuals, non-beta-lactams were associated with adverse drug reactions more often than penicillins or cephalosporins, independent of the penicillin skin test result. Cephalosporins were used as or more safely than non-beta-lactams in both penicillin skin test positive and negative individuals.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • California
  • Case-Control Studies
  • Cephalosporins / administration & dosage
  • Cephalosporins / adverse effects
  • Cephalosporins / classification
  • Child
  • Cohort Studies
  • Drug Hypersensitivity / diagnosis*
  • Drug Hypersensitivity / etiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypersensitivity, Immediate / chemically induced
  • Hypersensitivity, Immediate / diagnosis
  • Male
  • Middle Aged
  • Penicillins / administration & dosage*
  • Penicillins / adverse effects*
  • Penicillins / classification
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Skin Tests*
  • Statistics as Topic
  • Time
  • Treatment Failure


  • Cephalosporins
  • Penicillins