The Use of Penicillin Skin Testing to Assess the Prevalence of Penicillin Allergy in an Emergency Department Setting - 14/09/13
Address for correspondence: Joseph Moellman, MD, University of Cincinnati, Department of Emergency Medicine, Cincinnati, OH 45221-0769; 513-558-5281, Fax 513-558-5791Résumé |
Study objective |
Patient-reported penicillin allergies are often unreliable and can result in unnecessary changes in antibiotic therapy. Although penicillin allergy skin testing is commonly performed in allergy clinics, it has not been used in emergency departments (EDs) to verify self-reported allergies. We hypothesize that ED-based testing is possible and that the false-positive rate of patients with self-reported penicillin allergy are greater than 90%.
Methods |
This prospective observational cohort study enrolled a convenience sample of ED patients with a self-reported penicillin allergy. Patients were enrolled by one of 2 emergency physicians who performed skin prick and intracutaneous tests with penicillin major and minor determinants. The total testing time was 30 minutes. The proportion of false-positive self-reported allergies was computed with 95% confidence intervals (CIs) by using the score method.
Results |
A total of 150 patients (mean age 42 years; SD 16 years; 46% men; 47% black) were enrolled. The false-positive rate for self-reported penicillin allergy was 137 of 150 (91.3%; 95% CI 85.3% to 95.1%). There were no adverse reactions associated with penicillin skin testing. Compared with patients with a false-positive penicillin allergy result (confirmed by negative penicillin skin testing result), patients reporting a true penicillin allergy confirmed by positive penicillin skin test results tended to be more frequently men (61.5% versus 44.5%; Δ 17.0%; 95% CI −13.5% to 42%), black (69.2% versus 44.5%; Δ 24.7%; 95% CI −6.9% to 46.8%), and have no family history of drug allergy (7.7% versus 17.5%; Δ9.8%; 95% CI −20.9% to 20.4%), but self-reported other drug allergies more frequently (61.5% versus 38.7%; Δ 22.9%; 95% CI −7.7% to 47.5%).
Conclusion |
Penicillin skin testing is feasible in the ED setting. A substantial number of patients who self-report a penicillin allergy do not exhibit immunoglobulin E-mediated sensitization to penicillin major and minor determinants. Penicillin testing in the ED may allow the use of more appropriate antibiotics for patients presenting with a history of penicillin allergy.
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| Provide process.asp?qs_id=4410 on this article at the journal's Web site, www.annemergmed.com. |
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| Supervising editor: Gregory J. Moran, MD |
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| Author contributions: ASR, CJL, JAB, CDC, and JJM conceived the study and designed the trial. ASR and JJM obtained research funding and conducted the trial and data collection. CDL provided statistical advice on study design and analyzed the data. ASR and JJM drafted the article, and all authors contributed substantially to its revision. JJM takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Supported by a Resident Research Grant from the University of Cincinnati Department of Emergency Medicine. |
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| Publication date: Available online February 13, 2009. |
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| Reprints not available from the authors. |
Vol 54 - N° 1
P. 72-77 - juillet 2009 Retour au numéro
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