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To the Editor:—
The recent Clinical Note "Penicilloyl-Polylysine Skin Test" by Resnik and Shelley (196:740, 1966) describes a patient in whom an anaphylactic reaction to penicilloyl-polylysine (PPL) developed in a skin test, whereas he tolerated oral administration of penicillin without allergic reaction. The authors are, of course, correct in stating that skin testing with PPL carries with it the possible hazard of anaphylaxis and that certain patients with positive PPL tests may receive penicillin without adverse reaction. However, these conclusions should not be taken to indicate that the penicillin skin tests are dangerous or that they have no value.First, it is well-known that skin testing with any allergen carries with it the possibility of an anaphylactic reaction. However, when the minimal dose necessary to elicit a wheal-and-flare reaction is used for testing, the risk of anaphylaxis is negligible, especially when compared to the useful information that these tests
Bernard B. Levine, Anthony P. Redmond, Howard E. Voss. Penicilloyl-Polylysine Skin Tests and Allergies. JAMA. 1966;197(1):61–62. doi:10.1001/jama.1966.03110010113038