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Skin testing only with penicillin G in children with a history of penicillin allergy.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2014-05-27)
Matthieu Picard, Louis Paradis, Philippe Bégin, Jean Paradis, Anne Des Roches
ABSTRACT

The absence of commercially available penicilloyl-polylysine (PPL) for most of the last decade severely hampered the practice of penicillin allergy evaluation because skin testing without PPL is reported to have a poor negative predictive value (NPV). To determine the safety and NPV of skin testing without PPL using only penicillin G followed by a 3-dose graded challenge to the incriminated penicillin in children with a history of penicillin allergy. Patients evaluated for a history of penicillin allergy at the CHU Sainte-Justine Allergy Clinic between December 2006 and December 2009 were skin tested only with penicillin G and underwent a 3-dose graded challenge to the culprit penicillin if the skin test result was negative. Among 563 patients skin tested to penicillin G, 185 (33%) had a positive skin test result. These patients had a shorter interval between the initial reaction and skin testing compared with patients with a negative skin test result (P = .03). A total of 375 of 378 patients (99%) with a negative skin test result were challenged and 18 (4.8%) reacted, translating into a NPV of 95.2% (95% confidence interval [CI], 92.5%-97.1%). Three of 17 patients with a history of anaphylaxis and a negative skin test result reacted to challenge (NPV, 82.4%; 95% CI, 59.0-93.8%). All challenge reactions were mild and resolved promptly with treatment. Among children with a history of penicillin allergy, skin testing only with penicillin G followed by a 3-dose graded challenge to the incriminated penicillin is safe and yields a good NPV. This approach could be useful when PPL is unavailable.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Penicillin G sodium salt, powder, BioReagent, suitable for cell culture
Sigma-Aldrich
Penicillin G sodium salt, 96.0-102.0%
Sigma-Aldrich
Penicillin G potassium salt, powder, BioReagent, suitable for cell culture
Sigma-Aldrich
Penicillin G sodium salt, ~1650 U/mg
Sigma-Aldrich
Penicillin G potassium salt, ~1600 U/mg
Supelco
Penicillin G potassium salt, VETRANAL®, analytical standard
Benzylpenicillin sodium, European Pharmacopoeia (EP) Reference Standard
USP
Penicillin G potassium, United States Pharmacopeia (USP) Reference Standard
Sigma-Aldrich
Penicillin G potassium salt
Benzylpenicillin potassium, European Pharmacopoeia (EP) Reference Standard

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