Penicillin Allergy Testing Should Be Part of Pre-Op Evaluation

Penicillin allergy is the most frequent form of drug allergy
Penicillin allergy is the most frequent form of drug allergy

ATLANTA, GA—Penicillin allergy testing should be undertaken as part of preoperative evaluation for patients reporting penicillin allergy, suggest findings from a retrospective case control study presented at the 2017 AAAAI Annual Meeting.

“Incorporating penicillin allergy testing as a component of the preoperative evaluation process reduces the use of vancomycin, clindamycin, and levofloxacin in patients with a history of penicillin allergy,” said study author Keith A. Sacco, MD, of Mayo Clinic in Jacksonville, FL.

Penicillin allergy is the most frequent form of drug allergy, but up to 90% of self-reported cases actually tolerate penicillins, noted Dr. Sacco. 

To determine if perioperative antibiotic use can be changed by penicillin allergy testing during preoperative evaluation, Dr. Sacco compared the use of vancomycin, clindamycin, and levofloxacin among patients with histories of penicillin allergy who were referred for penicillin allergy testing, and those who were not tested preoperatively, in 2014 and 2015. The primary outcome of the study was the utilization of vancomycin, clindamycin, and levofloxacin. 

“During the studied time period, 853 (7.5%) patients reported a history of penicillin allergy, and of these, 442 (51.8%) were referred for penicillin allergy testing,” Dr. Sacco reported. “Of these 442 patients, 405 (91.6%) had negative penicillin allergy skin tests and were given clearance to receive penicillin or cephalosporin antibiotics. For the group of patients who had reported penicillin allergy and were referred for penicillin allergy testing, the use of vancomycin, clindamycin, and levofloxacin were all significantly reduced (P<0.001) by 32%, 19.4%, and 7.5%, respectively, compared to the group who did not have penicillin allergy testing.”

Limitations of the study included study design (retrospective, observational analysis) and limited data on adverse events of "second-line" antibiotics, noted Dr. Sacco. 

Results of this analysis found that penicillin allergy testing is beneficial in patients with a penicillin allergy, as it reduces the use of vancomycin, clindamycin, and levofloxacin. Dr. Sacco concluded, "penicillin allergy testing should be a standard component of the preoperative evaluation."