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Cited by 344Drug-Induced Adverse ReactionsFood Allergy and Anaphylaxis ResearchContact Dermatitis and Allergies

Clinical experience with penicillin skin testing in a large inner-city STD clinic.

Gadde, Jyothi·1993·JAMA: The Journal of the American Medical Association
DOI 10.1001/jama.1993.03510200062033
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Abstract

OBJECTIVE: To establish (1) the prevalence of positive penicillin skin tests among outpatients with well-defined but variable history of penicillin allergy and (2) the reproducibility, safety, and negative predictive value of skin testing with benzylpenicilloyl polylysine (PPL) and a minor-determinant mixture (MDM). DESIGN: Serial consenting outpatients with current indications for penicillin therapy were skin-tested in duplicate with PPL and MDM. Subjects with negative skin tests (93% of those positive by history and 95% of those negative by history) received therapeutic courses of benzylpenicillin (81%) or ampicillin (19%). Negative predictive value of skin testing was established by 72-hour follow-up for adverse reactions to drug. SETTING/PATIENTS: A total of 5063 consecutive, qualifying outpatients in a Baltimore, Md, sexually transmitted disease (STD) clinic. The study group was young (73% between 20 and 40 years old), 66% male, and 90% black; 25% had history of atopy. Follow-up was 94% complete. RESULTS: Positive skin tests were observed in 7.1% of 776 individuals with previous history of penicillin allergy and in 1.7% of 4287 subjects negative by history (P << .001). Previous history of anaphylaxis or urticaria was associated with significantly higher rates of positive skin tests of 17.3% and 12.4%, respectively (P<<.001). Only 4% with history of exanthem had positive skin tests (P = .03). The coefficient of variation for duplicate skin tests was 11%. Time intervals since last penicillin treatment did not influence the rate of positive skin tests. Adverse reactions to skin tests occurred in 13 (1.2% of patients positive by history; 9.4% of those with positive skin tests). A mild anaphylactic reaction occurred in one individual whose preliminary scratch testing was inadvertently omitted; systemic pruritus or urticaria occurred in 11 subjects; one had a large local reaction. After penicillin administration to individuals with negative skin tests, acute allergic reactions occurred in 0.5% of subjects negative by history compared with 2.9% of subjects positive by history (chi 2 = 33.3; P = .0001). Reactions were generally mild and self-limited; only two cases of mild anaphylactic reaction occurred, both in patients with history of severe IgE-mediated reaction. CONCLUSIONS: Skin testing with both major and minor penicillin determinants is safe using current recommendations, and both reagents are necessary for maximizing the identification of sensitized subjects. Routine penicillin skin testing can facilitate the safe use of penicillin in 90% of individuals with a previous history of penicillin allergy.

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Crossref · 10.1001/jama.1993.03510200062033

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  • One large study in an STI clinic revealed that 8.3% of patients reported penicillin or another ß-lactam antibiotic allergy.

    “One large study in an STI clinic revealed that 8.3% of patients reported penicillin or another ß-lactam antibiotic allergy (659).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [659]

  • In a Baltimore, Maryland, STI clinic study, only 7.1% of the patients who reported allergy to penicillin or to another ß-lactam antibiotic had an objective positive test for penicillin allergy.

    “In a Baltimore, Maryland, STI clinic study, only 7.1% of the patients who reported allergy to penicillin or to another ß-lactam antibiotic had an objective positive test for penicillin allergy (659).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [659]

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Authors
Gadde, J.
Affiliations
Johns Hopkins University (US)
Corresponding author
Gadde, Jyothi
Venue
JAMA: The Journal of the American Medical Association
Publisher
American Medical Association (AMA)
Published
1993-11-24
Volume
270
Issue
20
Pages
2456
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.1993.03510200062033
OpenAlex
W2013965125
Cited by
344
References
35
Citations by year
2026: 9 · 2025: 11 · 2024: 17 · 2023: 9 · 2022: 17 · 2021: 10 · 2020: 9 · 2019: 11 · 2018: 15 · 2017: 15 · 2016: 11 · 2015: 13 · 2014: 14 · 2013: 8 · 2012: 7
FWCI
2.66
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Allergy and Infectious Diseases (AI 11936)
Topics
  • Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
  • Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
  • Health Sciences › Medicine › Dermatology › Contact Dermatitis and Allergies
Keywords
penicillin allergy, penicillin skin testing, negative predictive value, anaphylaxis, urticaria, penicillin G, ampicillin, inner-city population, atopy
MeSH terms
Adult, Aged, Ambulatory Care Facilities, Drug Hypersensitivity, Female, Humans, Intradermal Tests, Male, Middle Aged, Penicillin G, Penicillins, Predictive Value of Tests, Sexually Transmitted Diseases, Skin Tests, Time Factors, Urban Health, Baltimore, Reproducibility of Results, Benzeneacetamides

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