We thank our colleagues for their valuable contribution to the ongoing debate on diagnostic precision of various in vitro and in vivo tests in the diagnosis of penicillin allergy. Our opinion is in line with theirs, namely that the precision of the tests applied should be evaluated against a gold standard, that is, oral or intravenous challenge with the culprit drug (except, of course, in cases of for example TEN, Stevens-Johnsons syndrome, DRESS, AGEP, or vasculitis, but including anaphylaxis). This strategy has, however, not been included in the present international guidelines.
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