title: Penicillin skin testing is a safe and effective tool for evaluating penicillin allergy in the pediatric population.
abstract: BACKGROUND
  Penicillin skin testing has been validated in the evaluation of adult patients with penicillin allergy. However, the commercially available benzylpenicilloyl polylysine (Pre-Pen) is not indicated in the pediatric population. Moreover, the safety and validity of penicillin skin testing in the pediatric population has not been well studied.
  
  
  OBJECTIVE
  We describe the safety and validity of penicillin skin testing in the evaluation of children with a history of penicillin allergy.
  
  
  METHODS
  Children (<18 years) with a history of penicillin allergy were evaluated with penicillin skin tests and were reviewed for basic demographics, penicillin skin test results, adverse drug reaction to penicillin after penicillin skin test, and adverse reaction to penicillin skin test. By using the χ(2) test, we compared the differences in the proportion of children and adults with a positive penicillin skin test. P value (<.05) was considered statistically significant. The institutional review board approved the study, and all the subjects signed written informed consents.
  
  
  RESULTS
  A total of 778 children underwent penicillin skin testing; 703 of 778 patients had a negative penicillin skin test (90.4%), 66 had a positive test (8.5%), and 9 had an equivocal test (1.1%). Children were more likely to have a positive penicillin skin test (P < .0001) compared with adults (64 of 1759 [3.6%]); 369 of 703 patients with negative penicillin skin test (52%) were challenged with penicillin, and 14 of 369 patients (3.8%) had an adverse drug reaction. No adverse reactions to penicillin skin testing were observed.
  
  
  CONCLUSIONS
  Penicillin skin testing was safe and effective in the evaluation of children with a history of penicillin allergy.
authors.affiliation: Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Fox
authors.affiliation: Division of Allergic Diseases, Mayo Clinic, Rochester, Minn. Electronic address: park.miguel@mayo.edu.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Park
mesh_terms: D000368:Aged; D044482:Benzeneacetamides; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000031:analogs & derivatives; D010406:Penicillins / Q000009:adverse effects / Q000276:immunology*; D012882:Skin Tests / Q000379:methods / Q000706:statistics & numerical data*
chemical_list: D044482:Benzeneacetamides; D010406:Penicillins; C509029:benzylpenicilloyl G polylysine; D010400:Penicillin G
keywords: Adverse drug reaction; Pediatric; Penicillin allergy; Penicillin skin testing; Safe