Piperacillin-Tazobactam Allergy Testing Guidelines

Skin Testing Protocol

The American Academy of Allergy, Asthma, and Immunology recommends evaluating the nature and severity of the previous penicillin reaction to guide the testing approach 3
Recent or severe reactions may require more cautious testing approaches, as recommended by the American College of Allergy, Asthma, and Immunology 1
Skin prick testing should be followed by intradermal testing if the prick test is negative, according to the Journal of Allergy and Clinical Immunology 2
Appropriate controls, including a positive control with histamine 4 and a negative control with saline 2, should be used during skin testing

The American Academy of Allergy, Asthma, and Immunology suggests performing skin testing with penicillin major and minor determinants, including PPL (Pre-Pen) at 6 × 10⁻⁵ mol/L 1 and penicillin G at 10,000 units/mL 1, 2
If these tests are negative, piperacillin-tazobactam skin testing should be performed with a nonirritating concentration, as recommended by the American College of Allergy, Asthma, and Immunology 1, 2
A positive test is defined by a wheal that is ≥3 mm larger than the negative control with a ≥5 mm flare, according to the Journal of Allergy and Clinical Immunology 1, 5

Following negative skin test results, an elective challenge with piperacillin-tazobactam is recommended by the American College of Allergy, Asthma, and Immunology 1, 2
The challenge is typically completed in 1 step, but a 2-step challenge may be considered if the reaction history is severe and/or recent, as suggested by the Journal of Allergy and Clinical Immunology 1, 4
Penicillin skin testing is safe, with <2% of skin test-positive patients experiencing systemic reactions, according to the American Academy of Allergy, Asthma, and Immunology 1

Skin testing should only be performed by personnel trained and skilled in the application and interpretation of this type of testing, with preparedness to treat rare anaphylaxis, as recommended by the American College of Allergy, Asthma, and Immunology 2
Penicillin skin testing should not be performed on patients with histories of severe non-IgE-mediated allergic reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, according to the Journal of Allergy and Clinical Immunology 6