Investigation of package inserts for physicians in skin test kits for detecting allergies to antibiotic agents in Japan

To avoid serious adverse reactions, especially anaphylactic shock, a skin test to detect allergy is recommended prior to the administration of antimicrobial drugs. Japanese pharmaceutical companies provide skin test kits appropriate for each drug, specifying how to administer and interpret the skin test in a package insert for physicians. However, procedures are not consistent between products. We therefore examined package inserts accompanying skin tests for allergies to antimicrobial drugs in use at the Hiroshima University Hospital, including five penicillin, 13 cephalosporin, and four carbapenem preparations. Preparation of test solutions followed five different protocols. Positive responses were defined by four different criteria, and three different intervals between inoculation and reading times were specified. Such differences in procedures between skin test kits appear likely to confuse physicians when using and interpreting the tests. These results suggest that standardization of skin tests would promote more rational and effective use of antimicrobial drugs.