The Role of Skin Testing for Penicillin Allergy

To the Editor.—  We believe that a recent article by Redelmeier and Sox¹ has left readers with an erroneous perception regarding the utility of penicillin skin testing.Redelmeier and Sox state that "the indications for performing the skin test remain unclear because results do not always predict correctly whether the patient will have a serious allergic reaction." This is contrary to the overwhelming majority of published reports^2-8 on penicillin skin testing, which clearly show that if a patient has a negative skin test result to benzyl penicilloyl (Pre Pen) and a mix of minor determinants, the subsequent risk of an IgE-mediated allergic reaction to penicillin is less than 1%. These rare reactions after negative penicillin skin test results tend to be mild urticaria. We are unaware of any life-threatening allergic reaction following negative penicillin skin test results.The authors state that approximately 5% of patients with negative skin