Treatment
ÎPenicillin G left in solution ("aged" penicillin) does not spontaneously degrade to form antigenic determinants and has no role in penicillin skin testing. (B)
ÎPenicillin skin testing without the major determinant is not recommended because this would fail to identify many patients with penicillin-specific IgE antibodies. (B)
ÎWhen penicillin skin testing is conducted by skilled personnel using proper technique, serious reactions are extremely rare. (C)
ÎPenicillin skin testing may be performed electively when patients are well and not in immediate need of antibiotic therapy. Alternatively, penicillin skin testing may be performed when treatment with a penicillin compound is contemplated. (D)
ÎPatients who have had negative skin test results to penicillin major and minor determinants may receive penicillin with minimal risk of an IgE-mediated reaction. Depending on the reaction history, the first dose may need to be given via graded challenge. (D)
ÎPenicillin skin test-positive patients should avoid penicillin, but if they develop an absolute need for penicillin, rapid induction of drug tolerance may be performed. (B)
ÎResensitization after treatment with oral penicillin is rare, and therefore penicillin skin testing does not routinely need to be repeated in patients with a history of penicillin allergy who have tolerated one or more courses of oral penicillin. (B)
ÎResensitization after treatment with parenteral penicillin appears to be higher than for oral treatment, and therefore repeat penicillin skin testing may be considered in patients with a history of penicillin allergy who have tolerated a course of parenteral penicillin. (C)
ÎThe negative predictive value of penicillin skin testing without penicilloylpolylysine is poor because many allergic patients show skin test reactivity only to the major determinant. (B)
ÎWhen penicillin skin testing is unavailable, evaluation of penicillin allergy is based on the reaction history and likelihood of needing treatment with penicillins. (C)
ÎPatients with a vague and/or distant history of penicillin allergy may be candidates to receive penicillins via graded challenge. Give penicillins to patients with recent or convincing reaction histories only via rapid induction of drug tolerance. (C)
ÎThe usefulness of in vitro tests for penicillin-specific IgE is limited by their uncertain predictive value. They are not suitable substitutes for penicillin skin testing. (C)
10
