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Cited by 275Drug-Induced Adverse ReactionsPharmacovigilance and Adverse Drug ReactionsContact Dermatitis and Allergies

Safely diagnosing clinically significant penicillin allergy using only penicilloyl-poly-lysine, penicillin, and oral amoxicillin.

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Macy, Eric, Ngor, Eunis W.·2013·The Journal of Allergy and Clinical Immunology In Practice
DOI 10.1016/j.jaip.2013.02.002
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Abstract

Background Penicillin skin testing is rarely used to undiagnose penicillin "allergy" in the United States, partially because of concern that commercially available materials are inadequate.Objective We determined whether skin testing with only commercially available penicilloyl-poly-lysine and penicillin followed by an oral amoxicillin challenge, if skin test-negative, can safely identify clinically significant penicillin allergy.Methods Five hundred sequential persons with positive history of penicillin "allergy" were evaluated by skin testing with penicilloyl-poly-lysine and penicillin between June 8, 2010, and March 29, 2012. All persons with negative skin tests were given an oral amoxicillin challenge and observed for 1 hour.Results Persons undergoing penicillin allergy testing were representative of all health plan members with penicillin allergy. Only 4 persons (0.8%; 95% CI, 0.32%-2.03%) had a positive skin test result. Only 4 persons (0.8%; 95% CI, 0.32%-2.03%) had an acute objective oral amoxicillin challenge reaction. Fifteen persons (3.0%; 95% CI, 1.83%-4.98%) had subjective oral challenge reactions, either acute transient itching or dizziness. All were women and 11 (73.3%) had multiple drug intolerance syndrome. None had severe reactions or objective signs. These were not considered to be positive challenge reactions. Sixty-eight subjects (13.6%) who were negative on testing were exposed to 88 courses of penicillins during 90 days of follow-up. New reactions were reported after 4 courses (4.5%), 3 (75%) occurring in subjects with multiple drug intolerance syndrome.Conclusions Penicillin skin testing, using only penicilloyl-poly-lysine and penicillin, followed by oral amoxicillin challenge, if negative, can safely identify clinically significant IgE-mediated penicillin allergy in patients who use health care in the United States at this time.

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  • Penicillin skin testing with a major determinant analog (penicilloyl-polylysine) and minor determinants (benzylpenicilloate, benzylpenilloate, or benzylpenicillin isomers of penicillin) are used for skin test evaluation for IgE-dependent penicillin allergy and can reliably identify persons at high risk for IgE-mediated reactions to penicillin.

    “Penicillin skin testing with a major determinant analog (penicilloyl-polylysine) and minor determinants (benzylpenicilloate, benzylpenilloate, or benzylpenicillin isomers of penicillin) are used for skin test evaluation for IgE-dependent penicillin allergy and can reliably identify persons at high risk for IgE-mediated reactions to penicillin (658,660,676).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [660]

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  • Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication.

    “Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication (660).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [660]

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  1. Macy E, Goldberg B, Poon KWT. Use of commercial anti-penicillin-IgE FEIAs to diagnose penicillin allergy. Ann Allergy Asthma Immunol 2010;105:136-41.

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Authors
Macy, E., & Ngor, E. W.
Affiliations
Kaiser Permanente (US)
Corresponding author
Macy, Eric
ORCID
Macy, Eric
Venue
The Journal of Allergy and Clinical Immunology In Practice
Publisher
Elsevier BV
Published
2013-05
Volume
1
Issue
3
Pages
258-263
ISSN
2213-2198 (ISSN-L)
DOI
10.1016/j.jaip.2013.02.002
OpenAlex
W2136352256
Cited by
275
References
24
Citations by year
2026: 9 · 2025: 9 · 2024: 16 · 2023: 19 · 2022: 22 · 2021: 18 · 2020: 33 · 2019: 35 · 2018: 25 · 2017: 29 · 2016: 23 · 2015: 14 · 2014: 17 · 2013: 5
FWCI
14.44
Type
journal article
Language
en
Open access
Licence
Locations
  • The Journal of Allergy and Clinical Immunology In Practice (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
  • Health Sciences › Medicine › Dermatology › Contact Dermatitis and Allergies
Keywords
penicillin allergy, penicillin skin testing, IgE-mediated drug allergy, drug hypersensitivity testing, health insurance beneficiaries
MeSH terms
Administration, Oral, Adolescent, Adult, Aged, Amoxicillin, Female, Humans, Male, Middle Aged, Penicillanic Acid, Penicillins, Polylysine, Prospective Studies, Retrospective Studies, Skin Tests, Benzeneacetamides, Young Adult

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