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The utility of skin testing in suspected clindamycin allergy

Knowles, S.R., Notman, M.J., Phillips, E.J., Weber, E.A. and Shear, N.H. (2003) The utility of skin testing in suspected clindamycin allergy. In: American Academy of Allergy Asthma & Immunology (AAAAI) 60th Anniversary Meeting, 7 - 12 March 2003, Denver, CO.


RATIONALE: Skin testing has been validated for lgE-mediated reactions associated with penicillin but little information exists regarding this form of testing for other drugs. We explored the clinical utility of clindamycin prick testing and intradermal testing in patients with immediate or delayed reactions to clindamycin. METHODS: A total of 34 subjects with histories of reactions associated with clindamycin (14 accelerated reactions, 11 delayed, and 8 not documented) underwent prick and intradermal skin testing to clindamycin (0.15 mg/ml to 15 mg/ml) between 1999 and 2001. Subjects with negative skin testing received a single oral dose of clindamycin. RESULTS: Although none of the 34 prick and intradermal tests per- formed were positive, a significant number of patients [11/34 (32%)] had reactions to the oral challenge lie, immediate reactions (n=l) and accelerated reactions (n= 10)]. Sensitivity of the prick and intradermal testing was determined to be 0%, specificity 100%, positive predictive value 0%, and negative predictive value 68%. CONCLUSIONS: Our experience highlights the low clinical utility of prick and intradermal testing for allergic and cutaneous reactions associated with clindamycin. We caution against the use of clindamycin skin testing as a diagnostic tool in this setting. Although a single oral challenge appears to be highly predictive it should be used selectively given the potential for significant morbidity incurred by induced reactions.

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