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

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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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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: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The Journal of Allergy and Clinical Immunology In Practice (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology (medical) › 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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Safely diagnosing clinically significant penicillin allergy using only penicilloyl-poly-lysine, penicillin, and oral amoxicillin.

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