Amoxicillin Challenges in Marine Recruits Reporting Penicillin Allergy
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Jeremy D. Waldram, MD, Mark H. Tucker, MD
Rationale: Marine recruits commonly report a beta lactam allergy upon arriving to boot camp. This has significant implications during and after recruit training, but logistics typically prevent evaluation.

Methods: Over a 13 month period, 244 Marine recruits in San Diego, CA were evaluated for beta lactam allergy. They reported being allergic to these medications on their intake paperwork. Data regarding reaction history, exposure since reaction, and additional medical history was obtained prior to evaluation. Seventy-five recruits underwent penicillin skin testing followed by oral challenge to amoxicillin 250mg if skin test negative, while 169 recruits had oral challenge without skin testing. Recruits with negative oral challenges went on to receive intramuscular penicillin G per standard recruit prophylaxis protocol.

Results: All 75 recruits who underwent penicillin skin testing had negative skin tests and negative oral challenges to amoxicillin. Of the 169 recruits that proceeded directly to oral challenge, 168 (99.4%) had a negative challenge. A single recruit developed neck erythema, globus, and throat itching after oral challenge. The symptoms responded rapidly to intramuscular epinephrine and diphenhydramine. All of the 243 recruits having had negative amoxicillin challenges successfully received their routine prophylactic intramuscular penicillin G injection without reaction.

Conclusions: Oral beta lactam challenge without prior penicillin skin testing may be an efficient, safe, and cost-reducing method of evaluating military recruits with reported beta lactam allergy.

 The views expressed herein are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government