Penicillin skin testing
- Roland Solensky, MD
Roland Solensky, MD
- Oregon State University/Oregon Health and Science University College of Pharmacy
Penicillin skin testing is a tool used in the diagnosis of penicillin allergy. This topic will review the indications, safety, protocols, and interpretation of skin testing with penicillin and the aminopenicillins (amoxicillin and ampicillin).
An overview of allergy skin testing (for various types of allergens), a general discussion of the diagnosis of drug allergy, and the clinical manifestations of penicillin allergy, are discussed separately. (See "Overview of skin testing for allergic disease" and "An approach to the patient with drug allergy" and "Penicillin allergy: Immediate reactions".)
IMMEDIATE PENICILLIN REACTIONS
Penicillins include the following:
●The natural penicillins – Penicillin V (oral), penicillin G (parenteral), benzathine penicillin (intramuscular), and procaine penicillin (intramuscular)
●The antistaphylococcal penicillins – Dicloxacillin, nafcillin, oxacillin, and cloxacillin
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- Amoxicillin is available from Sigma-Aldrich, St Louis, MO (product number A 8523). This preparation is not intended for human administration, and use in skin testing may require IRB approval at some centers. www.sigmaldrich.com (Accessed on October 10, 2011).
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- IMMEDIATE PENICILLIN REACTIONS
- MECHANISM OF SKIN TESTING
- Patient preparation
- Skin testing reagents and concentrations
- - Controls
- - Major determinant
- - Minor determinants
- - Aminopenicillins
- - Clavulanate testing in patient reactive to amoxicillin-clavulanate
- INTERPRETATION OF RESULTS
- Positive predictive value
- Negative predictive value
- - Confirmatory challenge after negative skin testing
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS