Skin testing to detect penicillin allergy

J Allergy Clin Immunol. 1981 Sep;68(3):171-80. doi: 10.1016/0091-6749(81)90180-9.

Abstract

Skin testing for penicillin allergy with penicillin G (Pen G), penicilloic acid (PA), and penicilloyl poly-L-lysine (PPL) was performed on 740 subjects, and the results were assessed from epidemiologic and immunologic perspectives. Approximately 95% of these patients had histories of apparent allergic reactions to beta-lactam antibiotics, and 63% were skin-test positive. The prevalence of positive skin tests was related to the time that had elapsed between clinical reactions and skin testing. Ninety-three percent were skin-test positive 7 to 12 mo after reactions, and 22% were positive 10 yr or more after reactions. Patients under 30 yr of age had a prevalence of positive skin tests 1.7-fold higher than older patients. Testing with PPL, PA, and Pen G detected 76.3%, 55.3%, and 57.1% of the positive patients, respectively. Omission of PPL, PA, or Pen G would have led to a failure to detect 25.6%, 7.2%, and 6.2% of the positive patients, respectively. Subjects with skin tests positive to penicillin often reacted to skin tests with other beta-lactam antibiotics; 73% (41 of 56) reacted to ampicillin and 51% (38 of 74) reacted to cephalothin. No serious allergic reactions were provoked by testing. None of the 83 skin test--negative patients treated with beta-lactam antibiotics immediately after testing experienced acute allergic reactions. Two patients developed mild urticaria beginning 3 and 5 days into therapy. One skin test--negative patient experienced urticaria 3 hr after receiving oral penicillin 6 mo after skin testing. This patient's skin-test status immediately before therapy was unknown. These results support the position that testing with PPL, PA, and Pen G is a rapid, safe, and effective method for identifying patients at risk, or not at risk, for allergic reactions to penicillin.

MeSH terms

  • Adolescent
  • Adult
  • African Continental Ancestry Group
  • Aging
  • Ampicillin / adverse effects
  • Benzeneacetamides
  • Carbenicillin / adverse effects
  • Cephalothin / adverse effects
  • Drug Hypersensitivity / diagnosis
  • Drug Hypersensitivity / etiology*
  • Female
  • Humans
  • Intradermal Tests
  • Lactams / adverse effects
  • Male
  • Penicillanic Acid / adverse effects
  • Penicillin G / adverse effects
  • Penicillin G / analogs & derivatives
  • Penicillins / adverse effects*
  • Polylysine / adverse effects
  • Polylysine / analogs & derivatives
  • Skin Tests
  • Time Factors

Substances

  • Benzeneacetamides
  • Lactams
  • Penicillins
  • Polylysine
  • benzylpenicillenic acid
  • penicilloyl polylysine
  • Ampicillin
  • Penicillanic Acid
  • Carbenicillin
  • Penicillin G
  • Cephalothin