A Pilot Study of Penicillin Skin Testing in Patients With a History of Penicillin Allergy Admitted to a Medical ICU

• Published in: Chest Vol. 118; no. 4; pp. 1106 - 1108
• Main Authors: Arroliga, Mercedes E., Wagner, William, Bobek, Mary Beth, Hoffman-Hogg, Lori, Gordon, Steven M., Arroliga, Alejandro C.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.10.2000; American College of Chest Physicians; Elsevier B.V
• Subjects: Adult; Aged; Aged, 80 and over; anaphylaxis; antibiotic resistance; antibiotic therapy; Benzeneacetamides; Biological and medical sciences; Complications and side effects; Diagnosis; Drug allergy; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - epidemiology; Drug Hypersensitivity - etiology; Drug toxicity and drugs side effects treatment; Female; Humans; ICU; Incidence; Intensive Care Units - statistics & numerical data; Male; Medical sciences; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Ohio - epidemiology; Patient Admission - statistics & numerical data; Penicillin; penicillin allergy; Penicillin G - adverse effects; Penicillin G - analogs & derivatives; Penicillins - adverse effects; Pharmacology. Drug treatments; Pilot Projects; Prospective Studies; skin test; Skin Tests; Ohio; antibiotic therapy; penicillin allergy; BPP; antibiotic resistance; anaphylaxis; ICU; skin test; Human; Immunopathology; Allergy; Antibiotic; Medical prescription; Penicillin; Exploration; Decision criterion; Diagnosis; Intensive care unit; Therapeutic assistance; Skin test
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.118.4.1106

Penicillin skin testing is an accuratemethod to determine whether a person with a history of penicillinallergy is at risk of having an immediate reaction to penicillin. Apatient with a negative reaction to a skin test may be able to use apenicillin compound safely, which could reduce the use of broad-spectrum antibiotics in this patient population. We prospectively studied all patients withhistories of penicillin allergy who were admitted to a medical ICUduring a 3-month period and who received antibiotics. Skin testing wasperformed with benzylpenicilloyl polylysine and penicillin G. Wedetermined the incidence of true allergy, the percentage of patients inwhom antibiotic coverage was modified, and the safety of the test. Two hundred fifty-seven patients were admitted tothe medical ICU of The Cleveland Clinic Foundation during the studyperiod. Twenty-four patients (9%), labeled as penicillin allergic andreceiving antibiotics, were enrolled. Three patients (13%, 3 of 21)gave histories of type I reaction to penicillin and were not skintested. Twenty patients (95%, 20 of 21) had negative skin testreactions to penicillin and positive skin test reactions to histaminecontrol. One patient (4%, 1 of 21) with negative skin test reactionsto both penicillin and histamine control had a test dose challenge withpiperacillin that was well tolerated. There were no adverseevents. Antibiotic coverage was changed in 10 patients (48%) as aresult of skin testing. Most patients withhistories of allergy to penicillin have negative reactions to skintests and may receive penicillin safely. Penicillin skin testing can beutilized as a safe and effective strategy to reduce the use of broad-spectrum antibiotics.