Penicillin allergy skin testing was safe in patients with low lung volumes before lung transplant in this study from Mayo Clinic in Florida.
Penicillin allergy is the most frequently reported drug hypersensitivity reaction, with a prevalence rate of approximately 10% in the United States; however, true reactions exist in only approximately 3% of patients reporting a penicillin allergy.
The study was a retrospective review of lung transplant candidates who underwent preoperative penicillin skin testing at Mayo Clinic Hospitals in Rochester, Minnesota, and Jacksonville, Florida over a period of 7 years.
Only 90 (?) patients had a reported history of penicillin allergy, 34% were referred for an allergy consultation and underwent penicillin skin testing. The number seems to be a bit low considering the expected volume of patients at Mayo.
Percutaneous tests were performed on the anterior part of the forearm and included a positive control and a negative control. A response of at least 3-mm diameter (with equivalent erythema) more than that of the diluent control done simultaneously was considered a positive test result. Intradermal testing was subsequently performed with 0.02 to 0.05 mL of the agents in case of negative skin prick test results. Skin testing was performed with benzylpenicilloyl polylysine as the major determinant and penicillin G potassium as well as penicilloate as the minor determinants and possible oral amoxicillin challenge.
Median age was 49 years. Median forced expiratory volume in 1 second (FEV1) was 1.29 L in males vs 1.26 L in females. The median percentage predicted FEV1 was 37%.
Only 1 patient had a positive skin test result to benzylpenicilloyl polylysine. No adverse events were reported.
A prior retrospective study included 39 patients before lung transplant with a history of penicillin allergy and a mean FEV1 of 0.65 L (24% predicted) reported similar findings.
References:
https://www.annallergy.org/article/S1081-1206(18)31195-5/fulltext
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