Research article summary (published 30 Jan 2002):

Controlled administration of penicillin to patients with a positive history but negative skin and specific serum IgE tests.

Full Abstract

BACKGROUND: Although subjects with a positive history of immediate allergy to penicillin and negative skin test are traditionally considered to tolerate penicillin, current evidence indicates that they may develop an immediate reaction despite negative skin and serum specific IgE tests. It is thought that these patients require additional tests to confirm the diagnosis. OBJECTIVE: To assess in a large group of patients with a history of immediate allergy to penicillins but with both skin test and CAP-FEIA-negative to classical and side chain penicillin determinants, the role of controlled administration of betalactams as a diagnostic test. METHODS: A group of 330 patients with a history of immediate allergic reactions to penicillins was studied by two evaluators from the same allergy unit using the following protocol: skin tests with major and minor determinants of benzylpenicillin (benzylpenicilloyl-poly l-lysine and minor determinant mixture), amoxicillin and ampicillin, and determination of specific IgE antibodies to penicillins, by CAP-FEIA, in serum. If both tests proved negative, a controlled administration of the drug was then carried out. RESULTS: A total of 89 (27%) patients were skin test and CAP-FEIA-negative and therefore required controlled administration of the drug. Of these, 49 developed an immediate response and were therefore considered allergic, and the remainder had good tolerance after administration of both benzylpenicillin and amoxicillin. The clinical characteristics of this group were similar to the other allergic patients who were skin test or CAP-FEIA-positive, except that they were younger (P < 0.01). Twenty-two (45%) developed a response to benzylpenicillin and 27 (55%) had a selective response to amoxicillin. Although all reactions appeared within 1 h, a positive correlation was found between the dose inducing the response and the time elapsed from drug administration, for both benzylpenicillin and amoxicillin (P < 0.001). CONCLUSION: These data indicate that an important number of subjects are not correctly identified if only skin tests and/or CAP-FEIA are used and that this is particularly relevant for side chain-specific reactions and younger subjects. This suggests that new diagnostic tests are required so as to limit the use of controlled administration.

Author information

Author/s: Torres, M J (MJ); Mayorga, C (C); Leyva, L (L); Guzman, A E (AE); Cornejo-García, J A (JA); Juarez, C (C); Blanca, M (M);

Affiliation: Research Unit for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (Clin Exp Allergy), published in England. (Language: eng)

Reference: 2002-Feb; vol 32 (issue 2) : pp 270-6

Dates: Created 2002/04/03; Completed 2002/08/02; Revised 2006/11/15;

PMID: 11929493, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Allergy. 2003 May;58(5):452. (PMID: 12752336)

CommentIn: Clin Exp Allergy. 2003 May;33(5):714. (PMID: 12752603)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent Adult Aged Amoxicillin - administration & dosage; diagnostic use; immunology Antibodies - blood Drug Hypersensitivity - blood; diagnosis; immunology Female Humans

Humans Immunoglobulin E - blood Male Medical Records Middle Aged Penicillin G - administration & dosage; diagnostic use; immunology Penicillins - administration & dosage; immunology Skin Tests

Associated Chemicals: Antibodies (0) ; Penicillins (0) ; Amoxicillin (26787-78-0) ; Immunoglobulin E (37341-29-0) ; Penicillin G (61-33-6)

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