Skin testing only with penicillin G in children with a history of penicillin allergy

Assessing the Diagnostic Properties of a Graded Oral Provocation Challenge for the Diagnosis of Immediate and Nonimmediate Reactions to Amoxicillin in Children

“…However, recent studies suggest that testing with PRE-PEN and penicillin G vs PRE-PEN and a minor determinant mixture would not substantially increase the number of falsenegative cases and that penicillin G can be safely used as an alternative to a minor determinant mixture in diagnosing penicillin allergy. 44,45 Finally, given that not all participants required full subsequent treatment with amoxicillin, we were able to determine the percentage of false-negative results for only a subgroup of participants rather than all 818 participants. Hence, we were not able to provide sensitivity estimates.…”

Oral challenge without skin tests in children with non‐severe beta‐lactam hypersensitivity: Time to change the paradigm?

“…The risk of death due to anaphylactic shock after oral administration of amoxicillin in the general population is extremely low . Under controlled conditions, positive OPT have usually been mild in children with a history of non‐severe cutaneous reactions, or even in children with a history of anaphylactic reactions and negative skin tests, and severe reactions are very uncommon and easily treated . On the other hand, OPT have been very rarely performed on children (and adults) with positive skin tests or with a history of severe delayed cutaneous‐systemic reactions (Stevens‐Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, DRESS syndrome…), in accordance with precautions and contraindications reaffirmed in the last International Consensus on drug allergy …”

“…The risk of death due to anaphylactic shock after oral administration of amoxicillin in the general population is extremely low. 20 Under controlled conditions, positive OPT have usually been mild in children with a history of non-severe cutaneous reactions, 4,7,10,15 or even in children with a history of anaphylactic reactions and negative skin tests, 12,21,22 and severe reactions are very uncommon and easily treated. 11,23 On the other hand, OPT have been very rarely performed on children (and adults) with positive skin tests 4…”

Penicillin allergy

“…Even though penicilloyl-poly-lysine has been shown on multiple occasions to identify over 80% of all individuals positive to any penicillin skin test reagent, Picard et al [26] only used native penicillin G at 10 000 units/ml to skin test 563 children between 2006 and 2009 in Canada, because it was all that was commercially available to them at the time. They used an appropriate 5 mm of wheal as the definition of a positive test result and noted 185 (33%) skin test-positive patients.…”