PURPOSE OF THE STUDY.
To evaluate safety and validity of penicillin skin testing in the evaluation of pediatric patients with a history of penicillin allergy.
Included in this study were 778 children who underwent penicillin skin testing (PST) using benzylpenicilloyl polylysine (PRE-PEN), penicillin (PCN) G potassium, amoxicillin, and alkaline hydrolysis mix (penicilloate) between July 8, 1993, and August 21, 2009. Inclusion criteria were as follows: patient had PST, had a history of penicillin (PCN) or cephalosporin allergy, and was <18 years of age. The mean ± SD age was 5 ± 3.5 years, and 47.1% were female.
This was a retrospective cohort study from the Mayo Clinic (Rochester, MN) in which medical records were reviewed for basic demographics (age and gender), type of adverse reaction (ADR) to penicillin or cephalosporin, PST results, time from original PCN ADR to testing, and adverse reactions to PCN after negative PST. The χ2 test was used to compare the differences in the proportion of children and adults with a positive PCN skin test. P < .05 was considered statistically significant.
Among the study participants, 703 had a negative PST (90.4%), 66 had a positive test (8.5%), and 9 had equivocal tests (1.1%). Three hundred sixty-nine of 703 patients with negative PST (52%) were challenged with PCN; 14 of these 369 (3.8%) had an adverse drug reaction. Of the 14 with reactions, 12 were isolated to the skin, and 2 children had serum sickness. There were no adverse reactions to PST.
This study confirms that penicillin skin testing was safe and effective in the evaluation of children with a history of PCN allergy.
Multiple studies in the adult population have shown that the prevalence of ADR after negative PST is low; however, studies in the pediatric population were lacking. This study confirmed that previous suspicion or diagnosis of “penicillin allergy” should be evaluated, that the testing is safe, and that reactions after negative tests are uncommon and typically not anaphylaxis. Importantly, skin testing excluded serious allergy for the vast majority in this study. The study is a good reminder to consider consulting an allergist for an evaluation rather than exclude this class of medications based solely on the history.
- Copyright © 2015 by the American Academy of Pediatrics