Standard Skin Tests for Antibiotic Allergies Are Ineffective, Study Finds

Traditional skin tests that are used to determine allergies to the common antibiotic amoxicillin don’t actually work, according to new research findings.

Moshe Ben-Shoshan, MD, allergist at the Montreal Children’s Hospital at the McGill University Health Centre (RI-MUHC) in Montreal, discovered that oral provocation or challenge test (PC), with appropriate follow-up, was a safer and more efficient screening method for diagnosing non-fatal reactions to amoxicillin in children.

JAMA Pediatrics

The study results were published in .

“Our study suggests that skin tests are essentially useless as diagnostic tests, and that we should go directly to the graded provocation test that is highly sensitive and specific. This is a game-changer in the way physicians assess amoxicillin allergy in children given the fact that skin tests are still the recommended screening method in hospitals,” Ben-Shoshan said in a news release.

The research team conducted a study involving 818 children who presented with a rash suspected from an allergic reaction to amoxicillin.

The PC tests were conducted with the suspected allergen; challenge tests were performed in a hospital or clinic to safely manage any serious reactions.

All the study participants underwent PC tests — 94.1% were tolerant to the graded PC. Additionally, only 17 experienced an immediate positive reaction to amoxicillin and 31 had non-immediate reactions that developed more than one hour after the challenge.

The researchers noted that this was the first study to actually determine the percentage of immediate and non-immediate amoxicillin allergy. “We showed that in children with a negative PC, amoxicillin can be safety used in the future, although under 10% could develop mild cutaneous symptoms upon subsequent exposure.”