Value Of Skin Testing Solely With Penicillin G In Children With a History Of Penicillin Allergy

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For most part of the last decade, PrePen® has been unavailable commercially. This situation has compromised the evaluation of many patients with a history of penicillin allergy. During this period, evaluation of children with a history of penicillin allergy continued in our center using penicillin G as the sole reagent for skin testing. We aimed to determine the negative predictive value and safety of this approach. We reviewed the files of all patients evaluated for a history of penicillin allergy between December 2006 and December 2009 at the CHU Sainte-Justine Allergy Clinic. Evaluation consisted of skin testing with penicillin G 10,000 IU/mL followed if negative by a graded challenge to the culprit penicillin. We evaluated 563 patients during this period. Among these, 185 (32.9%) had a positive skin test to penicillin G and 378 (67.1%) had a negative skin test. A reaction occurred in 4.8% (18/375) of patients following challenge. Three patients were not challenged. All reactions were mild and generally limited to the skin. The negative predictive value of skin testing solely with penicillin G was calculated at 95.2% (92.5-97.1%). This study raises questions about the relevance of skin testing children with a history of penicillin allergy with a large array of skin test reagents as the negative predictive value of penicillin G alone approximates that of the recommended approach. Also, it offers support for a simpler and safe alternative to skin testing in these children using penicillin G as the sole skin test reagent.