Elective penicillin skin testing in a pediatric outpatient setting

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Immunology
• Pharmacology

Background:

• Adverse reactions to penicillin antibiotics are frequent in children, often leading to unnecessary alternative antibiotic use.
• IgE-mediated penicillin allergy accounts for only a small portion of these adverse reactions.

Purpose of the Study:

• To analyze trends in penicillin skin test reactivity over a 10-year period.
• To determine the distribution of specific reagents in positive skin test results.
• To assess skin test reactivity in relation to patient reaction history.

Main Methods:

• A prospective study of 359 pediatric patients undergoing penicillin skin testing (benzylpenicilloyl polylysine, penicillin G, sodium penicilloate) from 1993-2003.
• Retrospective review of 562 previous penicillin skin test results (1979-1992).

Main Results:

• A significant decline in penicillin skin test sensitivity was observed between 1993 and 2003.
• Penicillin G and/or sodium penicilloate identified 34% of positive skin tests (1979-2002); sodium penicilloate alone accounted for 8.5%.
• No significant difference in positive skin test rates was found between patients with or without a history of suggestive IgE-mediated reactions.

Conclusions:

• Penicillin skin test sensitivity has markedly decreased in the pediatric population.
• Both penicillin G and sodium penicilloate are essential minor determinant reagents for accurate penicillin allergy assessment.
• Patient history alone is an unreliable predictor of penicillin sensitivity.