Current recommendations for the management of penicillin allergy are to perform penicillin skin testing (PST) with penicilloyl-polylysine (PPL) and benzylpenicillin (BP) prior to drug challenge with amoxicillin. However, the role of PST is increasingly questioned in the pediatric setting. To resolve the question of PST’s diagnostic accuracy, consecutive children with a history of non-life-threatening penicillin allergy referred to a tertiary-care allergy center were recruited to undergo double-blinded PST with PPL and BP prior to drug provocation to amoxicillin. Five of 158 participants (3.2%) presented with an immediate or accelerated reaction upon amoxicillin challenge, none of which were severe. Only one of these had positive PST (20%), compared to 15 of 153 amoxicillin tolerant participants (9.8%). The sensitivity and specificity of PST with PPL and BP for reacting upon amoxicillin challenge were 20% (95% CI: 0.5–71.6%) and 90% (95% CI: 84.4–94.4%), respectively. These results argue against the routine use of PST as a preliminary step to drug provocation with amoxicillin in this population, as it is unlikely to significantly alter pre-test probability of reacting to challenge.

中文翻译：

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小剂量双盲青霉素皮肤试验与阿莫西林口服激发有关的敏感性和特异性。

当前对青霉素过敏的管理建议是在用阿莫西林进行药物攻击之前，先用青霉素-聚赖氨酸（PPL）和苄青霉素（BP）进行青霉素皮肤测试（PST）。但是，PST的作用在儿科环境中越来越受到质疑。为了解决PST的诊断准确性问题，我们招募了具有非危及生命的青霉素过敏史的连续儿童，这些儿童被称为三级医疗过敏中心，接受了PPL和BP的双盲PST治疗，之后被激发为阿莫西林药物。158名参与者中有5名（3.2％）出现了阿莫西林激发后立即或加速的反应，但均无严重反应。其中只有一个PST阳性（20％），而153名阿莫西林耐受参与者中的15个（9.8％）。PST与PPL和BP对阿莫西林攻击的反应的敏感性和特异性分别为20％（95％CI：0.5–71.6％）和90％（95％CI：84.4–94.4％）。这些结果与该人群中常规使用PST作为阿莫西林药物激发的初步步骤相抵触，因为它不可能显着改变对挑战做出反应的测试前可能性。