Over-reliance on assays for specific IgE in diagnostics of penicillin allergy?

No need for skin and in vitro tests in most children with suspected allergy to beta‐lactam antibiotics

“…Some patients, especially those with severe allergy, have reactions during this process and must quit the procedure (1,2). An alternative for these cases is to use omalizumab, as an off-label indication, and there are reports of successful and safe results in this type of patients (3)(4)(5)(6). We report three cases of children with successful anti-IgE-assisted desensitization to egg who experienced reactions after discontinuation of omalizumab.…”

“…Oral provocation test with betalactam antibiotics in 11 children with positive skin tests gave only four mild, mainly delayed, skin reactions (positive predictive value of 36%) (3). The reliability of specific IgE test is probably very low (4). A recent study showed a positive predictive value of 0% for intradermal tests with cephalosporins (5).…”

Penicillin allergy

“…Commercially available in-vitro penicillin allergy tests that measure serum IgE against penicillins have been shown not to be clinically useful at this time because they correlate poorly to oral challenge results [21,22]. They currently add nothing to properly performed penicillin skin testing and oral challenges and can result in high rates of both false-positive and false-negative results.…”