Routine testing
for penicillin allergy no longer available at Children's
In recent years, Children's Hospital Boston has provided penicillin
allergy testing using a panel of penicillin derivatives for patients
with a possible allergy to this class of antibiotics. The absence
of skin test reaction to any component of this panel would reliably
predict that a patient could tolerate penicillin without anaphylactic
reaction.
But allergists and pediatricians have been dealt a major setback
with recent concurrent announcements that PrePen, one of the critical
testing reagents, will no longer be produced by its manufacturer,
and much of the existing PrePen is being recalled because of stability
concerns. Considerable pressure is being placed on the FDA and
PrePen manufacturer by the Children's allergy association, but
it is anticipated that this situation will be with us for at least
a year.
Without this reagent, the predictive value of testing is poor
so patients with negative tests will be at significant risk for
anaphylaxis upon challenge. In light of these limitations, penicillin
testing will not be routinely offered through the Children's Clinical
Allergy Program. There may be special clinical circumstances in
which testing might provide useful information, but this would
not be the case in the majority of outpatient antibiotic reactions.
As always, Clinical Allergy Program staff can assist in the evaluation
of patients with drug hypersensitivity and can help design strategies
for the treatment of drug-allergic children.
