Oral Challenge to Evaluate Patients with Low-Risk Reported Penicillin Allergies

Reported penicillin allergy leads to higher medical costs and excess complications; less than 10% of patients with reported allergies are truly allergic. Because penicillin skin testing has very good negative predictive value but poor positive predictive value and is not performed widely in community settings, researchers sought to determine whether oral challenges would identify patients for whom penicillin was safe.

In a prospective study, 642 Israeli patients (435 children) with histories of delayed penicillin reactions (i.e., reaction occurred ≥1 hour after the first dose or patient had no recollection of the reaction; mean elapsed time from alleged reaction, 7.1 years) underwent skin testing followed by oral challenge, regardless of ski…