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September 12, 2001

How Predictive Is a History of Penicillin Allergy?—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(10):1174-1175. doi:10.1001/jama.286.10.1173

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%.

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