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Ann Allergy Asthma Immunol. 2016 Jul;117(1):67-71. doi: 10.1016/j.anai.2016.04.021. Epub 2016 May 20.

Penicillin skin testing in hospitalized patients with β-lactam allergies: Effect on antibiotic selection and cost.

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Department of Pharmacy, Atlantic Health System, Overlook Medical Center, Summit, New Jersey. Electronic address:
Department of Medicine, Banner Baywood Medical Center, Mesa, Arizona.
Department of Pharmacy, Atlantic Health System, Overlook Medical Center, Summit, New Jersey.
Department of Medicine, Atlantic Health System, Overlook Medical Center, Summit, New Jersey; Division of Allergy and Immunology, Rutgers University Robert Wood Johnson University Hospital, New Brunswick, New Jersey; School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.



A history of a penicillin allergy generally leads to the use of broad-spectrum antibiotics that may increase complications and cost.


To determine the cost-effectiveness of performing penicillin skin testing (PST).


A retrospective analysis was conducted on adult inpatients with a β-lactam allergy who underwent PST and oral challenge performed by an allergist. The primary outcome was overall antibiotic cost savings for patients switched to a β-lactam antibiotic (BLA). Secondary outcomes included subsequent admissions that required antibiotics and total number of days a BLA was prescribed.


Fifty patients had PST performed (mean age, 62 years). The most common β-lactam allergy reported was penicillin (92%). Cutaneous reactions were reported in 54% of patients, and 56% had a reaction more than 20 years ago. Fifty percent of patients had aztreonam prescribed before PST. The results of PST were negative in all patients, and 1 patient had anaphylactic symptoms during the oral amoxicillin challenge (98% skin test or oral challenge negative). Thirty-seven patients (75.5%) were changed to a BLA. Overall cost savings were $11,005 ($297 per patient switched to a BLA). There were 31 subsequent admissions that required antibiotics for patients who tested negative on skin test and oral challenge. A BLA was prescribed in 22 of 31 readmissions, totaling 147 days of BLA therapy.


After the implementation of a PST protocol, we observed a decrease in non-BLA use in patients with previously documented β-lactam allergy. PST is a safe and cost-effective procedure to serve as a negative predictor test for penicillin hypersensitivity mediated by IgE.

[Indexed for MEDLINE]

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