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.

 

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