Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
In Reply: We disagree with Dr Macy and Dr Whitmore,
and believe that taking a detailed history to help exclude penicillin allergy
is supported by the literature. When patients had a valid history of penicillin
allergy, the frequency of a positive skin test was 27%, as opposed to 4% for
patients with an invalid history.1 In contrast
to the study of Macy et al, in which a limited number of patients received
skin testing,2 a larger study showed that
a history of a type I or IgE-mediated reaction correlated with skin test reactivity.
The incidence of a positive penicillin skin test result was 46%, 18%, 16%,
and 7% for patients with a history of anaphylaxis, angioedema, urticaria,
and maculopapular rash, respectively.1 Table
1 in our article further supports the role of the history in separating those
more or less likely to have a penicillin allergy as demonstrated by skin testing,
although the positive predictive value was 19%.
Salkind AR, Cuddy PG, Foxworth JW. How Predictive Is a History of Penicillin Allergy?—Reply. JAMA. 2001;286(10):1174-1175. doi:10.1001/jama.286.10.1173