SELECTED ARTICLES FROM THE RECENT LITERATURE 2008

4/28/2008

A New Commercial Skin Testing Kit for Penicillin Allergy

Summary
These Australian investigators evaluated 29 patients with a history of penicillin allergy using a penicillin skin testing kit from Diater Laboratories, Madrid, Spain. The kit consisted of a preparation of penicilloyl poly-L lysine (PPL) and a minor determinant mixture (MDM). The protocol was based on the manufacturer's suggested procedure for sequential testing starting with a skin prick test followed by intradermal test if prick testing was negative.

Patients with negative tests were challenged immediately after skin testing with 250 mg of whichever penicillin was taken at the time of their initial reaction if this preparation was known. Patients who could not recall the drug they took were given amoxicillin.

One patient developed anaphylaxis to intradermal testing. Of the remaining 25 patients with negative skin tests, 18 were challenged with amoxicillin, and 7 with penicillin. No immediate reactions occurred. However, 4 patients developed a delayed reaction at 6 hours or more after the challenge. All of the delayed reactions were rashes.

The authors concluded that their experience supported a high negative predictive value for excluding IgE-mediated allergy with "no immediate reactions occurring after challenge to amoxicillin or penicillin after negative skin testing."

Reference
Nolan RC, et al. Experience with a new commercial skin testing kit to identify IgE-mediated penicillin allergy. Internal Medicine Journal 2008; 38:357-367.

 

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