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Almost 8% of the U.S. population claims to be allergic to penicillin, but only a small proportion of these patients are truly allergic. Penicillin skin testing is the only way to identify IgE-mediated allergy (an immediate hypersensitivity reaction mediated by preformed IgE bound to the surface of mast cells and basophils). Penicilloyl-poly-lysine (Pre-Pen), the major determinant of penicillin allergy, has been available commercially since 2009, but clinicians rarely order skin testing. Some physicians are concerned that Pre-Pen testing is inadequate without also testing for minor determinants (penicilloate and penilloate), which are not readily available.
From 2010 to 2012, 500 patients with histories of penicillin allergy (based on diagnos…