Underutilization of Penicillin Skin Testing: A Call for Verifying Penicillin Allergy and Antibiotic Stewardship
Monday, March 7, 2016: 2:15 PM
Room 406AB (Convention Center)
Roxanne C. Oriel, MD, ,
Rationale: Penicillin (PCN) allergy is the most commonly reported medication allergy, self-reported by approximately 10% of the United States (US) population. Historically, 80-90% of patients with PCN allergy history were not allergic using penicillin skin testing (PST). Over the last 20 years, incidence of negative PST has increased to 95-98%.

Methods: A retrospective chart review at a 652-bed tertiary-care hospital from July 2011 to July 2014 was performed. Pre-Pen® orders in the electronic medical record were the trigger for inclusion. PST results were recorded for each patient.

Results: 102 patients were referred, 88 were tested. 87 (98.9%) of patients had negative prick/puncture (PP) and intradermal testing (IDT). One had negative PP, but positive IDT. Fourteen were excluded; 6 refused testing, 1 was on antihistamines, 5 had no PST documentation, and 2 had no documented PCN allergy by history.

Conclusions: Almost all patients with PCN allergy history are not PCN allergic and tolerate beta-lactams well. Consequently, using broad-spectrum antibiotics that increase Vancomycin-Resistant Enterococci and Clostridium difficile infections, hospital length of stay and medical costs, in non-PST verified PCN allergy, is problematic.

Less than 0.1% of 25 million individuals with PCN allergy history undergo PST in the US annually. The public health implications are compelling and PST should be performed before instituting alternative antibiotic therapy for PCN-sensitive infections.

PST remains a sensitive and reliable test for true PCN allergy. Educating specialties outside of our field on PST will identify more individuals with inaccurate PCN allergy diagnoses, increase referrals, and play a critical role in antibiotic stewardship.