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The acceptability of a four-part protocol for penicillin allergy testing by practicing allergists

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Currently, there is no standard protocol to test for penicillin (PCN) allergy since PrePen (manufactured benzylpenicilloyl polylysine; AllerQuest, West Hartford, CT) was discontinued in 2004. Our article reviews allergist's opinions on a protocol to test for PCN allergy in patients without a history of a life-threatening reaction. This study was performed to determine whether fellows of the American Academy of Allergy, Asthma, and Immunology (AAAAI) would use a two-challenge PCN allergy protocol to test for PCN allergy while skin testing to the major determinant, benzylpenicilloyl polylysine, is unavailable. A questionnaire regarding PCN allergy and application of a four-step protocol was sent to 1210 allergists and immunologists. Of the 654 respondents, 324 (49.5%) believed that the protocol was practical in a busy, outpatient allergy practice and 64 (9.8%) wanted more information. One hundred ninety-four (29.7%) did not think it was practical. Two hundred ninety-five respondents (45.1%) then went on to respond that they would apply the protocol in an outpatient practice and 117 (17.9%) were undecided and wanted more information. One hundred thirty-five respondents (20.6%) would not apply the protocol in their practice. Of those who were undecided or did not think it was practical, 58 (8.9%) were awaiting PrePen, 33 (5%) wanted to see a larger protocol, 24 (3.7%) wanted more detail on the challenge, and 14 (2.1%) felt more comfortable desensitizing the patient. Forty-five percent of the fellows of the AAAAI would apply the proposed protocol to test for PCN allergy. Sixty-two percent said they may apply the protocol if a larger study was performed.

Keywords: Allergy; RAST; benzylpenicilloyl polylysine; beta-lactam; major determinant; minor determinant; oral challenge; penicillin; skin test

Document Type: Research Article


Affiliations: Division of Allergy and Immunology, Alfred I. duPont Hospital for Children, Nemours Children’s Clinic, Wilmington, Delaware; Division of Allergy, Thomas Jefferson University, Philadelphia, Pennsylvania

Publication date: March 1, 2009

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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