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

The DOI matches its Crossref record; 35 of the 35 references it cites were found in a registry or an index.

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
Open this paper in CoChat — free account

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.

Overview

Integrity signals

Registry

Crossref · 10.1001/jama.1993.03510200062033

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Show all 35 references

Cited by

Sorted by citations

Items 301–344 of 344

Related

See all

Metadata

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 (medical) › 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

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review