Method of antimicrobial allergy testing

Skin testing, including skin-prick and intradermal testing, is the standard method used in specialised centres to test for immediate (IgE-mediated) hypersensitivity. Skin tests for penicillin and cephalosporin hypersensitivity should be performed by specialist clinicians. In patients with severe penicillin hypersensitivity, skin testing is typically used before oral challenge.

Oral challenge (also called drug challenge, drug provocation testing, graded challenge or test dosing) is the controlled administration of a drug to diagnose hypersensitivity. Oral challenge should only be performed under medical supervision, after consultation with a specialist. Direct oral challenge (ie oral challenge without prior skin testing) should only be performed in those with nonsevere penicillin hypersensitivity. For information about oral challenge in patients reporting penicillin hypersensitivity, see Allergy testing to confirm penicillin hypersensitivity in adults.

Detailed information about allergy testing (including protocols for oral penicillin challenge, and videos explaining how to perform intradermal and skin-prick testing) can be found on the National Antibiotic Allergy Network website. The Australasian Society of Clinical Immunology and Allergy (ASCIA) website contains useful resources for allergy testing (eg patient consent form).