To the Editor.
—We found the recent article by Dykewicz et al1 most valuable. We have a protocol for use of intravenous streptokinase in our community hospital with which we have treated more than 60 patients since January 1983. To date, we have observed no untoward effects, but we have excluded patients from the protocol who have received streptokinase five days to six months previously. Skin testing may be particularly valuable in this population so as not to deny them the value of thrombolytic therapy, or necessitate the use of a more expensive agent, urokinase. Care must be taken, however, to assure that the skin test does not delay timely administration of fibrinolytic therapy, particularly in the early stages of acute myocardial infarction.To facilitate the skin test procedure and assure availability of the solution, we have developed the following protocol. Rather than using a streptokinase skin test solution