A practical guide for pharmacists to successfully implement penicillin allergy skin testing

Am J Health Syst Pharm. 2019 Jan 25;76(3):136-147. doi: 10.1093/ajhp/zxy043.


Purpose: The purpose of this article is to offer practical guidance for pharmacists to successfully implement penicillin allergy skin testing (PAST).

Summary: Less than 10% of patients labeled as having a penicillin allergy are confirmed as present upon skin testing. This labeling results in use of alternative antibiotics and thus unwanted adverse consequences including potentiated antimicrobial resistance, increased costs, and worse clinical outcomes. Stewardship guidelines recommend PAST to enhance use of first-line agents; however, this was a weak recommendation with low-quality evidence. Recent efforts and subsequent research since publication of guidelines have demonstrated beneficial effects from increasing use of PAST among stewardship programs to improve outcomes. A number of different models exist demonstrating successful implementation of PAST at various healthcare facilities. There are important logistical factors to consider during implementation of PAST such as target population, optimal preparation, leadership structure, resource availability, and state regulations. Pharmacists as leaders of antimicrobial stewardship teams and experts in drug allergies are a natural fit to help implement PAST in healthcare settings to improve overall outcomes. This article offers guidance to institutions considering implementation of PAST.

Conclusion: PAST is rapidly becoming an effective, long-term antimicrobial stewardship tool to optimize antimicrobial prescribing in both the inpatient and outpatient settings. Pharmacists have demonstrated significant benefit as providers of PAST services in a variety of healthcare settings with a number of different healthcare professionals.

Publication types

  • Review

MeSH terms

  • Drug Hypersensitivity / diagnosis*
  • Drug Hypersensitivity / immunology
  • Humans
  • Penicillins / adverse effects*
  • Pharmacists / standards*
  • Professional Role*
  • Skin Irritancy Tests / methods
  • Skin Irritancy Tests / standards*
  • Skin Tests / methods
  • Skin Tests / standards


  • Penicillins