- Position paper from AAAAI: PCN skin testing should be performed routinely on patients reporting PCN allergy and it would be associated with reduced costs of care, increased patient safety and improved patient outcomes.: Lang et al. J Allergy Clin Immuno Pract. 2017;5:333-334.
- PCN allergy: Bhattacharya et al. J Adv Pharm Technol Res. 2010;1(1):11–17
- PCN and beta-lactam hypersensitivity: Har et al. Immunol Allergy Clin N Am 2017;37:643-662.
- PCN allergy; good discussion of stewardship implications: Castells et al. N Engl J Med. 2019;381:2338-2351.
Systematic Reviews / Meta-analysess
- 95% of PCN allergy labels have a negative skin test; inpatient PCN allergy testing is safe and effective in ruling out PCN allergy and patient with reported PCN and need for PCN should be tested while inpatient: Sacco et al. Allergy. 2017 Sep;72(9):1288-1296.
- The cost of self-reported PCN allergy: Mattingly et al. J Allergy Clin Immunol Pract. 2018;6:1649-1654.e4.
- first trial of use of PCN skin testing on inpatients for removal of PCN allergy label; 50-75% PPV and 93% NPV: Adkinson et al. N Engl J Med. 1971;285:22-24.
- PCN skin testing in the ICU reduced the use of broad-spectrum antibiotics: Arroliga et al. Chest. 2000;118(4):1106-8.
- Patients reporting a PCN allergy are very inaccurate: Borch et al. Basic Clin Pharmacol Toxicol. 2006 Apr;98(4):357-62.
- Less pre-op vancomycin use after a pre-op visit to allergy clinic for skin testing: Park et al. Ann Allergy Asthma Immunol. 2006;97(5):681-7.
- Patients with a negative skin test can safely receive beta-lactams; >90% can tolerate PCNs: del Real et al. Ann Allergy Asthma Immunol. 2007;98(4):355-9.
- Less pre-op vancomycin use after a pre-op visit to allergy clinic for skin testing: Frigas et al. Mayo Clin Proc. 2008;83(6):651-62.
- Listed antibiotic allergies often aren’t valid based on history and result in suboptimal antibiotic choice: Lutmoski et al. Pharmacotherapy. 2008;28(11):1348-53.
- PCN skin testing in the ED; >90% can tolerate PCNs: Raja et al. Ann Emerg Med. 2009;54(1):72-7.
- Patients reporting a PCN who have a negative skin test have a low risk of reacting to PCN; >90% can tolerate PCNs: Rimawi et al. J Hosp Med. 2013 Jun;8(6):341-5.
- Safety of a protocol to diagnose PCN allergy with skin testing and oral amoxicillin test dose: Macy et al. J Allergy Clin Immunol Pract. 2013;1(3):258-63.
- Patients with a PCN allergy label had a higher risk of receiving second-line antibiotic, more than 2 types of antibiotic, and increased risk of readmission than patients without an antibiotic allergy: van Dijk et al. J Allergy Clin Immunol Pract. Sep-Oct 2016;4(5):926-31.
- PCN allergy labels are associated with with increased antibiotic use including second-line antibiotic and more health care use: Su et al. Clin Transl Allergy. 2017 Jun 7;7:18.
- PCN allergy in MSSA bacteremia: pt treated with vancomycin had a higher mortality. use of beta-lactam was most strongly associated with mortality: Turner et al. Open Forum Infect Dis. 2018 Feb 19;5(3):ofy042.
- PCN allergy labels leads to less ideal antibiotic use: Trubiano et al. J Antimicrob Chemother. 2016;71:1715-1722.
- PCN skin tests are positive at a much lower rate when performed 10 years after the initial reaction, copmared to testing 7-12 months after: Sullivan et al. J Allergy Clin Immunol 1981;68:171-180.
- PCN allergy associated with higher cost, use of broader-spectrum antibiotic, and did not correlate with history of reaction: MacLaughlin et al. Arch Fam Med. 2000;9(8):722-6.
- A practice guideline for PCN skin testing improves the appropriateness of antibiotic: Forrest et al. Clin Infect Dis. 2001;32(12):1685-90.
- Economic burden of PCN-allergic patients: Sade et al. Clin Exp Allergy. 2003;33(4):501-6.
- Antibiotic allergy labels lead to worse outcomes: Charneski et al. Pharmacotherapy. 2011;31:742-747.
- PCN allergy label leads to increased antimicrobial resistance, cost of care, length of stay, and mortality: Unger et al. Pharmacotherapy. 2013;33 (8):856-867. https://doi.org/10.1002/phar.1288
- Patients with PCN allergy label have higher costs of care, inpatient and outpatient: Picard et al. J Allergy Clin Immunol Pract. 2013;1:252-257. https://doi.org/10.1016/j.jaip.2013.01.006
- Patients with PCN allergy get more second line antibiotic: Macy et al. J Allergy Clin Immunol. 2014;133(3):790-796. https://doi.org/10.1016/j.jaci.2013.09.021
- Patients with PCN allergy label have higher costs of care, inpatient and outpatient: Li et al. J Clin Pathol. 2014;67:1088-1092.
- Carbapenems can be used safely in 99% of patients after a skin test and challenge: Gaeta et al. J Allergy Clin Immunol. 2015;135:972-976.
- Impact of a clinical guideline for prescribing antibiotic to inpatients reporting PCN allergy; skips PCN testing in a lot of cases and uses only a test dose: Blumenthal et al. Ann Allergy Asthma Immunol. 2015;115(4):294-300.e2.
- Delabeling PCN allergy leads to decreased costs of care: King et al. Ann Allergy Asthma Immunol. 2016;117:67-71.
- Patients with PCN allergy label have prolonged hospitalizations and increased readmission rates: McFadden et al. Clin Infect Dis. 2016;63:904-910.
- PCN skin testing as part of antimicrobial stewardship run by ID fellows: Heil et al. Open Forum Infect Dis. 2016;3(3):ofw155.
- Only 2% of patients with a positive PCN skin test react to cephalosporins: Trubiano et al. J Allergy Clin Immunol Pract 2017;5:1532-1542.
- 90% of patients with reported PCN allergy test negative: Trubiano et al. JAMA 2017;318(1):82-83.
- Delabeling PCN allergy leads to decreased costs of care: Macy et al. J Allergy Clin Immunol. 2017;5(3):705-710.
- PCN skin testing as part of antimicrobial stewardship: Leis et al. Clin Infect Dis. 2017;65:1059-1065.
- PCN skin testing as part of antimicrobial stewardship managed by ID pharmacist and nursing: Jones et al. Am J Health Syst Pharm. 2017;74:232-237.
- Teachable moment: case of bad outcomes due to not assessing PCN allergy: Vaisman et al. JAMA Intern Med. 2017;177(2):269-270.
- Assessing PCN allergy as part of antimicrobial stewardship: Blumenthal et al. J Allergy Clin Immunol. 2017;140(1):154-161.e6.
- Screening for PCN allergy prior to arthroplasty to improve surgical prophylaxis practice: McDanel et al. J Arthroplasty 2017;32:9S:S101-S108.
- Impact of PCN allergy label on carbapenem use: Al-Hasan et al. Pharmacotherapy. 2018;38(1):42-50.
- Patients with PCN allergy label have a 50% higher chance of getting a surgical site infection: Blumenthal et al. Clin Infect Dis. 2018;66(3):329-336.
- Patients with PCN allergy label have increased rates of infection with MRSA, VRE, and C. diff: Blumenthal et al. BMJ 2018;361:k2400.
- Delabeling PCN allergy leads to decreased costs of care; use of clinical decision-support tool and algorithm for PCN testing: Chen et al. Open Forum Infect Dis. 2018;5(6):ofy106.
- PCN skin testing as an antimicrobial stewardship initiative in a community hospital led by ID pharmacist and nurses (wildly successful): Jones et al. Open Forum Infect Dis. 2019.
- Practical guide for pharmacists to implement PCN skin testing: Bland et al. Am J Health Syst Pharm. 2019;76:136-147.
- The time for PCN skin testing is here: Solensky. J Allergy Clin Immunol Pract. 2013;1(3):264-5.
- PCN allergy as a public health measure: Solenksy. J Allergy Clin Immunol. 2014;133(3):797-8.
Mandell chapter summary
Last updated 12/15/2020