The role of major and minor determinants in penicillin allergy testing: Time to revisit an old friend?
Penicillin skin testing
allergic reaction
drug allergy
penicillin
Journal
The journal of allergy and clinical immunology. Global
ISSN: 2772-8293
Titre abrégé: J Allergy Clin Immunol Glob
Pays: United States
ID NLM: 9918453488706676
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
04
11
2022
revised:
09
03
2023
accepted:
29
03
2023
medline:
2
10
2023
pubmed:
2
10
2023
entrez:
2
10
2023
Statut:
epublish
Résumé
Skin testing is an important step in evaluation of penicillin allergic reactions. It includes testing to the following: amoxicillin, benzyl penicillin, and products generated We aimed to evaluate the performance and utility of PPL and MDM in penicillin allergy testing. A retrospective audit over a 5-year period was undertaken for those with penicillin testing in a tertiary immunology unit. In all, 214 patients were identified. Of those patients, 151 (70.6%) were female and the average age was 58 years. Unspecified penicillin was the most common index drug (n = 127 [59.3%]), followed by amoxicillin (n =3 [24.8%]) and amoxicillin-clavulanic acid (n = 21 [9.7%]). The result of skin testing was positive in 23 patients (10.7%); skin prick testing was positive in 10 patients (4.7%), and intradermal testing (IDT) was positive in 13 patients (6.1%), the majority of whom had identified amoxicillin or amoxicillin-clavulanic acid as the index drug (n = 22 [95.7%]). The result of testing to PPL and/or MDM was positive with IDT only (n=5 [23.8%]). PPL and MDM positivity coexisted with a positive reaction to amoxicillin IDT in 2 patients, 1 of whom passed an amoxicillin challenge. Additionally, 2 positive tests to PPL were present with a negative result for MDM; of these 2 positive results, 1 was positive to amoxicillin IDT. In only 1 case were the results of testing for MDM and PPL both positive, with negative results to all native β-lactams tested; the patient tolerated an amoxicillin challenge. Overall, the negative predictive value for both skin prick testing and IDT was 89.5%. Benzyl penicillin and amoxicillin alone may be sufficient for
Sections du résumé
Background
UNASSIGNED
Skin testing is an important step in evaluation of penicillin allergic reactions. It includes testing to the following: amoxicillin, benzyl penicillin, and products generated
Objective
UNASSIGNED
We aimed to evaluate the performance and utility of PPL and MDM in penicillin allergy testing.
Methods
UNASSIGNED
A retrospective audit over a 5-year period was undertaken for those with penicillin testing in a tertiary immunology unit.
Results
UNASSIGNED
In all, 214 patients were identified. Of those patients, 151 (70.6%) were female and the average age was 58 years. Unspecified penicillin was the most common index drug (n = 127 [59.3%]), followed by amoxicillin (n =3 [24.8%]) and amoxicillin-clavulanic acid (n = 21 [9.7%]). The result of skin testing was positive in 23 patients (10.7%); skin prick testing was positive in 10 patients (4.7%), and intradermal testing (IDT) was positive in 13 patients (6.1%), the majority of whom had identified amoxicillin or amoxicillin-clavulanic acid as the index drug (n = 22 [95.7%]). The result of testing to PPL and/or MDM was positive with IDT only (n=5 [23.8%]). PPL and MDM positivity coexisted with a positive reaction to amoxicillin IDT in 2 patients, 1 of whom passed an amoxicillin challenge. Additionally, 2 positive tests to PPL were present with a negative result for MDM; of these 2 positive results, 1 was positive to amoxicillin IDT. In only 1 case were the results of testing for MDM and PPL both positive, with negative results to all native β-lactams tested; the patient tolerated an amoxicillin challenge. Overall, the negative predictive value for both skin prick testing and IDT was 89.5%.
Conclusion
UNASSIGNED
Benzyl penicillin and amoxicillin alone may be sufficient for
Identifiants
pubmed: 37781672
doi: 10.1016/j.jacig.2023.100132
pii: S2772-8293(23)00057-7
pmc: PMC10509867
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100132Informations de copyright
© 2023 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.
Références
Allergy. 2015 Aug;70(8):1013-9
pubmed: 25913298
J Allergy Clin Immunol. 2016 Apr;137(4):1148-1153
pubmed: 26688516
Int Arch Allergy Immunol. 2016;170(1):62-6
pubmed: 27387793
Curr Allergy Asthma Rep. 2014 Sep;14(9):459
pubmed: 25142495
J Allergy Clin Immunol Pract. 2015 Nov-Dec;3(6):883-7
pubmed: 26164809
Lancet Infect Dis. 2014 May;14(5):381-7
pubmed: 24657114
J Allergy Clin Immunol Pract. 2019 Sep - Oct;7(7):2173-2181.e1
pubmed: 30922992
Mayo Clin Proc. 2018 Jan;93(1):101-107
pubmed: 29304914
Expert Rev Clin Pharmacol. 2017 Jun;10(6):671-683
pubmed: 28375040
JAMA. 2019 Jan 15;321(2):188-199
pubmed: 30644987
Allergy. 2003 Oct;58(10):961-72
pubmed: 14510712
BMJ. 2018 Jun 27;361:k2400
pubmed: 29950489
Allergy. 2009 Feb;64(2):249-53
pubmed: 19133924
Allergy. 2018 Sep;73(9):1833-1841
pubmed: 29517808
J Allergy Clin Immunol. 2022 Dec;150(6):1333-1393
pubmed: 36122788
Allergy. 2020 Feb;75(2):273-288
pubmed: 31049971
J Allergy Clin Immunol Pract. 2020 Jun;8(6):1980-1986.e7
pubmed: 32006722
J Allergy Clin Immunol. 2004 Aug;114(2):371-6
pubmed: 15316518
Allergy. 2001 Sep;56(9):850-6
pubmed: 11551249
Ann Allergy Asthma Immunol. 2018 Nov;121(5):537-544
pubmed: 30248407
Ann Allergy Asthma Immunol. 2007 Jul;99(1):54-8
pubmed: 17650830
Allergy. 2017 Sep;72(9):1288-1296
pubmed: 28370003
Allergy Asthma Clin Immunol. 2015 Nov 20;11:34
pubmed: 26594228
J Allergy Clin Immunol. 2005 Nov;116(5):1167-8; author reply 1168-9
pubmed: 16275398
Intern Med J. 2022 Nov;52(11):1957-1961
pubmed: 34160122
J Allergy Clin Immunol. 2005 Jun;115(6):1314-6
pubmed: 15940154