Can We Skip Skin Testing and Go Right to a Direct Penicillin Challenge?

Several recent studies have addressed overuse of penicillin-allergy labeling. Although 10% of hospitalized patients have penicillin allergy listed in their records, fewer than 10% of those patients have true allergies. Use of more-expensive and broader-spectrum antibiotics is associated with longer and more-expensive hospital stays and more side effects, nosocomial infections, and resistant organisms.

In a systematic review of 56 studies, researchers examined the safety of direct penicillin challenges (without preceding skin tests) for delabeling patients without true allergies. Among more than 9000 patients in these studies, 438 experienced reactions (3.5%), with only 5 reactions classified as severe: 3 episodes of anaphylaxis, 1 delayed ra…