Diagnostic Value and Safety of Penicillin Skin Tests in Children with
Immediate Penicillin Allergy
Abstract
Background:The first-line method in the diagnosis of patients who
describe an immediate reaction after penicillin intake is skin
tests(ST)with penicillin reagents. We aimed to determine the safety and
diagnostic value of penicillin STs in the diagnosis of immediate
reactions to penicillins. Methods:The study included patients with
suspected immediate reaction to penicillin who were subjected to STs
using a standard penicillin test kit (Diater;Madrid,Spain) and suspected
penicillin and drug provocation tests(DPT) with suspected penicillin at
our clinic Results:A total of 191 patients(53.9%males)with a median age
of 6.83 years(inter-quartile range:4.2-12)were included in the study.The
time from drug intake to the onset of reaction was ā¤1 hour in
138(72.3%)patients and 1 to 6 hours in 53(27.7%)patients.Penicillin
allergy was confirmed by diagnostic tests in 36(18.8%)of 191
patients.In multivariate logistic regression analysis, history of both
urticaria and angioedema(odds ratio[OR]:27,683 95%confidence
interval[CI]:3.143-243.837,pā=ā0.003) and anaphylaxis (OR:56.246,
95%CI:6.598-479.489, pā<0.001) were main predictors of
penicillin allergy diagnosis. While STs were positive in
23(63.8%)patients, 13(26.2%)patients had positive DPT results despite
negative ST results. The negative predictive value(NPV)of STs was
calculated 92.2% (155/168).None of our patients experienced immediate
or delayed systemic/local reactions in relation to the STs.
Conclusions:History of urticaria with and anaphylaxis were main
predictors of true penicillin allergy in children with suspected
immediate reactions.Skin tests with penicillin reagents are safe for use
in children. Although STs have a high NPV, DPT is the gold standard for
diagnosis. Drug provocation tests should be performed as the final step
of the diagnostic evaluation of penicillin allergy in patients with
negative STs