Oral Challenge without Skin Testing Safely Excludes Clinically Significant Delayed-Onset Penicillin Hypersensitivity

Ronit Confino-Cohen, Yossi Rosman, Keren Meir-Shafrir, Tali Stauber, Idit Lachover-Roth, Alon Hershko, Arnon Goldberg

Research output: Contribution to journalArticlepeer-review

Abstract

Background Penicillins are the drug family most commonly associated with hypersensitivity reactions. Current guidelines recommend negative skin tests (ST) before re-administering penicillins to patients with previous nonimmediate reactions (NIR). Objective The objective of this study was to examine whether ST are necessary before re-administering penicillin to patients with NIR. Methods Patients with NIR to penicillins starting longer than 1 hour after last dose administration or starting any time after the first treatment day or patients with vague recollection of their reaction underwent penicillin ST. Disregarding ST results, patients were challenged with the relevant penicillins. One-tenth of the therapeutic dose followed by the full dose was administered at 1-hour interval and patients continued taking the full dose for 5 days. Results A total of 710 patients with alleged BL allergy were evaluated. Patients with a history of immediate reaction (52, 7.3%) or cephalosporin allergy (16, 2.2%) were excluded. Of the remaining 642 patients, 62.3% had negative ST, 5.3% positive ST, and 32.4% equivocal ST. A total of 617 (96.1%) patients were challenged. Immediate reaction was observed in 9 patients (1.5%): 1—positive ST, 7—negative ST, and 1—equivocal ST (P =.7). Late reaction to the first-day challenge occurred in 24 patients (4%). An at-home challenge was continued by 491 patients. Complete 5-day and partial challenges were well tolerated by 417 (85%) and 44 patients (8.9%), respectively, disregarding ST results. Thirty patients (6.1%) developed mild reactions to the home challenge regardless of their ST results. Conclusion A 5-day oral challenge without preceding ST is safe and sufficient to exclude penicillin allergy after NIR developing during penicillin treatment.

Original languageEnglish
Pages (from-to)669-675
Number of pages7
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume5
Issue number3
DOIs
StatePublished - May 2017

Keywords

  • Beta-lactams
  • Drug hypersensitivity
  • Nonimmediate penicillin allergy
  • Oral challenge

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