The Falling Rate of Positive Penicillin Skin Tests from 1995 to 2007

Overview

Journal Perm J

Specialties General Medicine
Health Services

Date 2011 Mar 5

PMID 21373225

Citations 32

Authors

Eric Macy

Michael Schatz

Ck Lin

Kwun-Yee Poon

Affiliations

Soon will be listed here.

Abstract

Background: Data on the rate of positive penicillin skin test (PenST) results over time in large populations are rare. The factors that influence positive PenST results are incompletely understood.

Objectives: We sought to correlate demographic variables to the rate of positive PenST results over time in a large group of patients with a history of penicillin allergy.

Methods: RESULTS from the first test for all patients tested for penicillin allergy in the Kaiser Permanente Health Care Program in San Diego County, CA, between 1995 and 2007 are reported. All patients were tested with penicillin, penicilloyl-poly-lysine, penilloate, penicilloate, and amoxicillin.

Results: There were 255 positive PenST results in 3469 individuals. The rate of positive PenST results declined from >10% to <5% during the 13 years studied. The positive PenST result rate could be accounted for by the year of testing (R(2) = 0.56; p = 0.003) without any significant contribution from the patient's age or the time since reaction (TSR). If the TSR was ≤13 years, the relative risk of a positive PenST result was 2.1 (95% confidence interval = 1.6-2.8). If the study subject's age was ≤38 years, the relative risk of a positive PenST result was 2.1 (95% confidence interval = 1.6-2.7). Females reported higher rates of penicillin allergy history than males did (11% compared with 6.6%; p < 0.0001), but there were no significant sex differences in the rate of positive PenST results.

Conclusions: There has been a steady decline in the proportion of positive PenST results between 1995 and 2007, independent of study subject age and TSR. Increasing age and increasing TSR were associated with a lower rate of positive PenST results.

Citing Articles

Determining the role of basophil activation testing in reported type 1 allergy to beta-lactam antibiotics.

Reitmajer M, Strauss A, Klinger C, Maass M, Kempf W, Fischer J Front Allergy. 2025; 5():1512875.

PMID: 39776672 PMC: 11703728. DOI: 10.3389/falgy.2024.1512875.

How to Define and Manage Low-Risk Drug Allergy Labels.

Copaescu A, Li L, Blumenthal K, Trubiano J J Allergy Clin Immunol Pract. 2024; 12(5):1095-1106.

PMID: 38724164 PMC: 11493333. DOI: 10.1016/j.jaip.2024.03.021.

Differences in beta-lactam and penicillin allergy: Beyond the West and focusing on Asia-Pacific.

Mak H, Yeung M, Wong J, Chiang V, Li P Front Allergy. 2022; 3:1059321.

PMID: 36483185 PMC: 9723361. DOI: 10.3389/falgy.2022.1059321.

β-lactam exposure outcome among patients with a documented allergy to penicillins post-implementation of a new electronic medical record system and alerting rules.

Buffone B, Lin Y, Grant J J Assoc Med Microbiol Infect Dis Can. 2022; 6(2):104-113.

PMID: 36341031 PMC: 9608696. DOI: 10.3138/jammi-2020-0050.

Penicillin Allergy Label Is Associated With Worse Clinical Outcomes in Bacterial Pneumonia.

Kaminsky L, Ghahramani A, Hussein R, Al-Shaikhly T J Allergy Clin Immunol Pract. 2022; 10(12):3262-3269.

PMID: 36182647 PMC: 10129071. DOI: 10.1016/j.jaip.2022.08.027.

References

Goldberg A, Confino-Cohen R . Skin testing and oral penicillin challenge in patients with a history of remote penicillin allergy. Ann Allergy Asthma Immunol. 2008; 100(1):37-43. DOI: 10.1016/S1081-1206(10)60402-4. View

Solensky R . Hypersensitivity reactions to beta-lactam antibiotics. Clin Rev Allergy Immunol. 2003; 24(3):201-20. DOI: 10.1385/CRIAI:24:3:201. View

Macy E, Roppe L, Schatz M . Routine Penicillin Skin Testing in Hospitalized Patients with a History of Penicillin Allergy. Perm J. 2015; 8(3):20-4. PMC: 4690693. DOI: 10.7812/TPP/04.934. View

Macy E . Risks of penicillin skin testing. Ann Allergy Asthma Immunol. 2000; 85(5):330-1. DOI: 10.1016/S1081-1206(10)62539-2. View

Nolan R, Puy R, Deckert K, OHehir R, Douglass J . Experience with a new commercial skin testing kit to identify IgE-mediated penicillin allergy. Intern Med J. 2008; 38(5):357-61. DOI: 10.1111/j.1445-5994.2008.01657.x. View

Torres M, Blanca M . Penicillin allergy. Allergy. 2003; 58(5):452. DOI: 10.1034/j.1398-9995.2003.00585.x. View

Jost B, Wedner H, Bloomberg G . Elective penicillin skin testing in a pediatric outpatient setting. Ann Allergy Asthma Immunol. 2007; 97(6):807-12. DOI: 10.1016/S1081-1206(10)60973-8. View

Macy E . Elective penicillin skin testing and amoxicillin challenge: effect on outpatient antibiotic use, cost, and clinical outcomes. J Allergy Clin Immunol. 1998; 102(2):281-5. DOI: 10.1016/s0091-6749(98)70097-1. View

Bousquet P, Pipet A, Bousquet-Rouanet L, Demoly P . Oral challenges are needed in the diagnosis of beta-lactam hypersensitivity. Clin Exp Allergy. 2007; 38(1):185-90. DOI: 10.1111/j.1365-2222.2007.02867.x. View

10.

JOHANSSON S, Hourihane J, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T . A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001; 56(9):813-24. DOI: 10.1034/j.1398-9995.2001.t01-1-00001.x. View

11.

Macy E, RICHTER P, Falkoff R, Zeiger R . Skin testing with penicilloate and penilloate prepared by an improved method: amoxicillin oral challenge in patients with negative skin test responses to penicillin reagents. J Allergy Clin Immunol. 1997; 100(5):586-91. DOI: 10.1016/s0091-6749(97)70159-3. View

12.

Mendelson L, RESSLER C, Rosen J, Selcow J . Routine elective penicillin allergy skin testing in children and adolescents: study of sensitization. J Allergy Clin Immunol. 1984; 73(1 Pt 1):76-81. DOI: 10.1016/0091-6749(84)90487-1. View

13.

Macy E, Lin C, Goldberg B . Penicilloyl-polylysine stability and clinical use over time. Perm J. 2011; 11(4):10-1. PMC: 3048433. DOI: 10.7812/TPP/07-063. View

14.

Bousquet P, Kvedariene V, Co-Minh H, Martins P, Rongier M, Arnoux B . Clinical presentation and time course in hypersensitivity reactions to beta-lactams. Allergy. 2007; 62(8):872-6. DOI: 10.1111/j.1398-9995.2007.01463.x. View

15.

Macy E, Mangat R, Burchette R . Penicillin skin testing in advance of need: multiyear follow-up in 568 test result-negative subjects exposed to oral penicillins. J Allergy Clin Immunol. 2003; 111(5):1111-5. DOI: 10.1067/mai.2003.1385. View

16.

Matheu V, Perez E, Gonzalez R, Poza P, de la Torre F, Sanchez-Machin I . Assessment of a new brand of determinants for skin testing in a large group of patients with suspected beta-lactam allergy. J Investig Allergol Clin Immunol. 2007; 17(4):257-60. View

17.

Green G, ROSENBLUM A, SWEET L . Evaluation of penicillin hypersensitivity: value of clinical history and skin testing with penicilloyl-polylysine and penicillin G. A cooperative prospective study of the penicillin study group of the American Academy of Allergy. J Allergy Clin Immunol. 1977; 60(6):339-45. DOI: 10.1016/0091-6749(77)90064-1. View

18.

Palma-Carlos M, Palma-Carlos A, Medina M . "In vivo" and "in vitro" tests in the diagnosis of Beta-lactams allergy. Eur Ann Allergy Clin Immunol. 2007; 39(5):157-61. View

19.

Macy E, Burchette R . Oral antibiotic adverse reactions after penicillin skin testing: multi-year follow-up. Allergy. 2002; 57(12):1151-8. DOI: 10.1034/j.1398-9995.2002.23700.x. View

20.

Reunala T, Alenius H, Turjanmaa K, Palosuo T . Latex allergy and skin. Curr Opin Allergy Clin Immunol. 2004; 4(5):397-401. DOI: 10.1097/00130832-200410000-00011. View