What is the role of penicillin skin testing in the evaluation of anaphylaxis?

Updated: May 16, 2018
  • Author: S Shahzad Mustafa, MD; Chief Editor: Michael A Kaliner, MD  more...
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Answer

If the patient’s history suggests a penicillin etiology and the reagents are available, skin testing for penicillin should be performed with the appropriate positive and negative controls. Penicillin G and major determinant (Pre-Pen; ALK-Abelló, Inc; Round Rock, Tex) are commercially available for skin testing. Of note, although the minor determinant mix (MDM) of penicillin comprises only 5% of penicillin metabolites, the MDM has also been implicated in anaphylaxis. The MDM, however, is not available commercially and generally only available at research centers. If the MDM can be used in conjunction with the commercially available penicillin skin testing, the negative predictive value increases from 97% to closer to 99%.


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