PMID- 30095396
OWN - NLM
STAT- MEDLINE
DCOM- 20190211
LR  - 20220818
IS  - 1539-6304 (Electronic)
IS  - 1088-5412 (Print)
IS  - 1088-5412 (Linking)
VI  - 39
IP  - 4
DP  - 2018 Jul 1
TI  - Penicillin skin testing in the management of penicillin allergy in an outpatient 
      pediatric population.
PG  - 305-310
LID - 10.2500/aap.2018.39.4138 [doi]
AB  - BACKGROUND: Eight to ten percent of patients believe that they are allergic to 
      penicillin, yet only 10% of those patients have evidence of an immunoglobulin E 
      (IgE) mediated allergy upon penicillin skin testing (PST). In the adult 
      population, a negative PST result is associated with a low risk of immediate 
      reaction on oral challenge, but further studies are needed in the pediatric 
      population. OBJECTIVE: To calculate the negative predictive value (NPV) of the 
      current skin testing regimen of penicillin, benzylpenicilloyl-polylysine (the 
      major determinant), and ampicillin in a pediatric outpatient population to assess 
      the utility of adding the minor determinant mixture to the skin testing regimen. 
      METHODS: A retrospective chart review was conducted of all pediatric patients 
      seen in a single-center pediatric allergy/immunology outpatient clinic between 
      January 1, 2010, and March 1, 2016, who underwent PST for presumed penicillin 
      drug allergy. RESULTS: Only 38% of patients who underwent PST had a drug reaction 
      history consistent with an IgE-mediated reaction. 28.8% of the patients had a 
      positive PST result. The addition of ampicillin to the standard PST regimen of 
      penicillin and benzylpenicilloyl-polylysine identified an additional 4.1% of 
      patients. Two patients (3.2%) reacted on oral challenge with a minor rash. The 
      NPV of the PST regimen was 98%. No significant predictive variables for a 
      positive PST result were identified. CONCLUSION: Given the high NPV of the 
      current PST regimen, we do not recommend additional testing with the minor 
      determinant mixture. Despite this high NPV, the utility of PST in the low-risk, 
      low-pretest probability outpatient pediatric population was limited, and select 
      patients may be able to proceed directly to oral challenge.
FAU - Anterasian, Christine M
AU  - Anterasian CM
FAU - Geng, Bob
AU  - Geng B
LA  - eng
GR  - K12 HD000850/HD/NICHD NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Allergy Asthma Proc
JT  - Allergy and asthma proceedings
JID - 9603640
RN  - 0 (Penicillins)
RN  - 37341-29-0 (Immunoglobulin E)
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Disease Management
MH  - Drug Hypersensitivity/*diagnosis/*epidemiology/immunology
MH  - Female
MH  - Humans
MH  - Immunoglobulin E/immunology
MH  - Infant
MH  - Male
MH  - Outpatients/*statistics & numerical data
MH  - Penicillins/*adverse effects
MH  - Population Surveillance
MH  - Retrospective Studies
MH  - Skin Tests
PMC - PMC9292462
EDAT- 2018/08/11 06:00
MHDA- 2019/02/12 06:00
PMCR- 2018/07/01
CRDT- 2018/08/11 06:00
PHST- 2018/08/11 06:00 [entrez]
PHST- 2018/08/11 06:00 [pubmed]
PHST- 2019/02/12 06:00 [medline]
PHST- 2018/07/01 00:00 [pmc-release]
AID - AAP188-17 [pii]
AID - 10.2500/aap.2018.39.4138 [doi]
PST - ppublish
SO  - Allergy Asthma Proc. 2018 Jul 1;39(4):305-310. doi: 10.2500/aap.2018.39.4138.