The value of skin testing for penicillin allergy in an inpatient population: analysis of the subsequent patient management.

Abstract

It was decided to assess the value of skin testing in a group of inpatients with a remote history of penicillin allergy, in terms of whether or not beta-lactams were subsequently given, if any adverse reactions occurred as a result of this therapy, and if labeling of the patient record was changed subsequent to skin testing and/or challenge. All patients seen in consultation with a history of penicillin allergy were assessed. When done, skin tests were performed with the major and minor determinants of penicillin and semisynthetic penicillins. Charts were reviewed after discharge in terms of the antibiotics given during admission, adverse events, and the medical record and hospital database labeling for drug allergy at discharge. Skin testing was carried out in 79% of 67 patients assessed and in all, the tests were negative. Beta-lactam therapy was recommended in 51/53 patients but was given in only 57% of these cases. At discharge, 49% of patients' records still carried the penicillin allergy label, despite negative skin testing and/or successful completion of a course of beta-lactam therapy. So, in approximately half of the patients reviewed, beta-lactams were not given despite negative skin tests and a recommendation to do so, if indicated, and 49% of patients were still inappropriately labeled as being penicillin-allergic on discharge.