Preferred Methods for De-Labeling Patients with Antibiotic Allergy

Elizabeth Phillips, MD, FRCPC, FRACP, Professor of Medicine, Pharmacology, and Pathology, Vanderbilt University Medical Center, explains the current preferred methods for drug skin testing and desensitization.

Interview Transcript (slightly modified for readability)

“In the clinic, we have specific methods that we use—skin testing and oral challenge—to de-label patients with antibiotic allergy. For penicillin, we’re fortunate in that we have validated reagents, which, when we use prick and skin testing in combination with oral challenge, gives 100% negative predictive value. So, we can say with certainty that a patient won’t have an immediate or life-threatening reaction in the future.

These are simple techniques that allergists are trained to do. The whole process takes about an hour and a half to two hours to perform—two steps on the skin, followed by a tablet by mouth. It’s valuable for patients; many of the patients that come in with this history have been labeled for decades and have a lot of fear associated with going through this process. It’s validating for patients when they can go through these steps, see the negative steps on their skin, and then actually get up the courage, if you will, to actually take a tablet and realize that they’re not truly allergic to penicillin.”