If you perform skin testing for a penicillin allergy, do you find skin prick testing necessary or do you only perform intradermal testing?

It’s time to take a serious look at the relative value of prick puncture testing for penicillin. With the exception of patients who have a history of severe anaphylaxis, intradermal testing should become standard.

Typically, penicillin skin testing is performed with prick testing first, and if that's negative, then ID testing. All the published studies have used this type of protocol. Some have even diluted the reagents an additional 10-fold for one more preceding prick ST (so 2 prick tests using a lower and higher concentration, then ID testing). However, it is extremely unusual to detect positive prick tests, so in my practice, unless a patient gives a recent history of anaphylaxis, I skip the prick tests and go directly to ID tests. I have found this to be safe, with no systemic reactions, but have yet to publish the data. The advantage of this one-step process is that it can be more easily accomplished during the initial consult, meaning the pati...