• Esther A King, Sridevi Challa, Patrick Curtin, and Leonard Bielory.
• Department of Pharmacy, Atlantic Health System, Overlook Medical Center, Summit, New Jersey. Electronic address: esther.king@atlantichealth.org.
• Ann. Allergy Asthma Immunol. 2016 Jul 1; 117 (1): 67-71.

BackgroundA history of a penicillin allergy generally leads to the use of broad-spectrum antibiotics that may increase complications and cost.ObjectiveTo determine the cost-effectiveness of performing penicillin skin testing (PST).MethodsA retrospective analysis was conducted on adult inpatients with a β-lactam allergy who underwent PST and oral challenge performed by an allergist. The primary outcome was overall antibiotic cost savings for patients switched to a β-lactam antibiotic (BLA). Secondary outcomes included subsequent admissions that required antibiotics and total number of days a BLA was prescribed.ResultsFifty patients had PST performed (mean age, 62 years). The most common β-lactam allergy reported was penicillin (92%). Cutaneous reactions were reported in 54% of patients, and 56% had a reaction more than 20 years ago. Fifty percent of patients had aztreonam prescribed before PST. The results of PST were negative in all patients, and 1 patient had anaphylactic symptoms during the oral amoxicillin challenge (98% skin test or oral challenge negative). Thirty-seven patients (75.5%) were changed to a BLA. Overall cost savings were $11,005 ($297 per patient switched to a BLA). There were 31 subsequent admissions that required antibiotics for patients who tested negative on skin test and oral challenge. A BLA was prescribed in 22 of 31 readmissions, totaling 147 days of BLA therapy.ConclusionAfter the implementation of a PST protocol, we observed a decrease in non-BLA use in patients with previously documented β-lactam allergy. PST is a safe and cost-effective procedure to serve as a negative predictor test for penicillin hypersensitivity mediated by IgE.Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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