No

Diagnostic Agent

Adjunct in assessing the risk of administering penicillin (penicillin or benzylpenicillin) in adults with a history of clinical penicillin hypersensitivity

C

Patients known to be extremely hypersensitive to penicillin

PPL test alone does not identify those patients who react to a minor antigenic determinant and does not appear to predict reliably the occurrence of late reactions. A negative skin test is associated with an incidence of allergic reactions <5% after penicillin administration and a positive skin test is associated with a >20% incidence of allergic reaction after penicillin administration; have epinephrine 1:1000 available.

1% to 10%: Local: Intense local inflammatory response at skin test site

<1%: Edema, pruritus, erythema, urticaria, wheal (locally), systemic allergic reactions occur rarely

Decreased effect: Corticosteroids and other immunosuppressive agents may inhibit the immune response to the skin test

Refrigerate; discard if left at room temperature for longer than one day

Elicits IgE antibodies which produce type I accelerate urticarial reactions to penicillins

PPL is administered by a scratch technique or by intradermal injection. For initial testing, PPL should always be applied via the scratch technique. Do not administer intradermally to patients who have positive reactions to a scratch test. PPL test alone does not identify those patients who react to a minor antigenic determinant and does not appear to predict reliably the occurrence of late reactions.

Intradermal test: Use intradermal test with a tuberculin syringe with a 26- to 30-gauge short bevel needle; a dose of 0.01-0.02 mL is injected intradermally. A control of 0.9% sodium chloride should be injected at least 1.5" from the PPL test site. Most skin responses to the intradermal test will develop within 5-15 minutes.

Interpretation:

(-) Negative: No reaction

(±) Ambiguous: Wheal only slightly larger than original bleb with or without erythematous flare and larger than control site

(+) Positive: Itching and marked increase in size of original bleb

Control site should be reactionless

PPL is administered by a scratch technique or by intradermal injection. For initial testing, PPL should always be applied via the scratch technique. Do not give intradermally to patients who have positive reactions to a scratch test.

No information available to require special precautions

No effects or complications reported

Always use scratch test for initial testing

Solution: 0.25 mL

Boguniewicz M and Leung DYM, "Hypersensitivity Reactions to Antibiotics Commonly Used in Children," Pediatr Infect Dis J, 1995, 14(3):221-31.

Lin RY, "A Perspective on Penicillin Allergy," Arch Intern Med, 1992, 152(5):930-7.

Sogn DD, Evans R 3d, Shepherd GM, et al, "Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to Test the Predictive Value of Skin Testing with Major and Minor Penicillin Derivatives in Hospitalized Adults," Arch Intern Med, 1992, 152(5):1025-32.

Sullivan TJ, Wedner HJ, Schatz GS, et al, "Skin Testing to Detect Penicillin Allergy," J Allergy Clin Immunol, 1981, 68:171-80.

Weiss ME and Adkinson NF, "b-lactam Allergy" in Principles & Practice of Infectious Diseases, 3rd ed, Mandell GL, Douglas RG, Bennett, JE, 1990, Churchill Livingstone, 264-9.

Wendel GD Jr, Stark BJ, Jamison RB, et al, "Penicillin Allergy and Desensitization in Serious Infections During Pregnancy," N Engl J Med, 1985, 312(19):1229-32.