Indications for skin testing:
(1) History of a non-anaphylactic IgE-mediated reaction (see previous section)
(2) A beta-lactam antibiotic is the drug of choice and no alternative drug is available.
(3) According to a guideline proposed by Forrest et al, intention to treat for 7 or more days of intravenous antibiotics. The rationale for this was economic, comparing the cost of skin testing vs cost of alternative therapy.
Nonindications (Salkind et al page 2502):
(1) Physician is not planning to use a beta-lactam antibiotic (although there is an argument to confirm allergy in certain populations such as children).
(2) Definite history of an anaphylactic or other life-threatening IgE-mediated reaction.
(3) History of a drug reaction not mediated by IgE, especially Stephens-Johnson to toxic epidermal necrolysis.
(4) If equally efficacious alternative antibiotic(s) is/are available.
Relative contraindication to immediate testing:
(1) Immediately after an anaphylactic reaction from any cause (false negative reaction due to temporary anergy following mast cell degranulation, Robinson et al page 28)
