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Medication Skin Testing and Oral Challenges

This letter offers more information about how to prepare for an appointment. Please read this letter carefully in advance of an upcoming challenge appointment.


Penicillin Testing – What To Expect

PRE-PEN is the only FDA approved skin test for the diagnosis of penicillin allergy. PRE-PEN is administered through both scratch and intradermal testing and quickly identifies patients who can safely receive penicillin.

Testing can be temporarily uncomfortable because five (5) needles are used for the intradermal portion. It is important your child be as still as possible during this step so they are not hurt.

It is estimated that penicillin allergy is overstated due to non-confirmed, self-reported patient history. Approximately 85% of patients who describe themselves as penicillin allergic will have negative skin tests and can safely receive penicillin and related antibiotics.

Testing agents:

  • Pre-Pen
  • PCN-G
  • Histamine
  • Negative control
  1. Skin scratch tests are done with all 4 agents – if after 15-20 minutes there are no bumps/blebs where the skin test were placed (except for histamine which should leave a temporary bump/bleb) you can move on to Step 2.
  2. Five (5) Intradermal injections (just under the top layers of skin to create a bubble under the skin) –
  1. Two (2) Pre-Pen
  2. Two (2) PCN-G
  3. One (1) Negative control

If no bumps/blebs after 15-20 minutes move to Step 3

  1. One tenth of a dose of Amoxicillin orally – (sometimes the entire dose is given)

If no signs of a reaction, move to Step 4

  1. Remainder of Amoxicillin orally (9/10th)
  2. Remain in clinic for one hour following last Amoxicillin dose


Questions about billing for challenges

To help avoid unexpected surprises, it may be helpful to check with your insurance company to find out what will be covered by them for your child’s challenge procedure. The CPT codes your insurance company may ask you for are: 95076 (first 2 hours of the appointment) and 95079 (each additional hour). You may also contact our clinic financial counselors at 984-974-9968 or 984-974-9972.