Abstract
The reliability of skin testing in the diagnosis of penicillin allergy was studied in 86 adults and 167 children with a history of possible hypersensitivity reactions to penicillin. Skin testing was done with the major antigenic determinant of benzylpenicillin and minor determinants of benzylpenicillin, ampicillin, cloxacillin, methicillin and cephalothin. The overall frequency of positive skin reactions was 11.5%. Among the patients with positive skin reactions about half had a history of immediate or accelerated reactions to penicillins, but 2 of 11 adults and 50% of the children in this group had a history of maculopapular rash of delayed onset. There was a low frequency of positive skin reactions when there was a long interval between the times of clinical reaction and skin testing. Of 169 patients reacting negatively to skin testing who received a specific drug challenge only 2 manifested mild urticaria; this indicates the reliability of the skin tests in predicting penicillin allergy. The major and minor determinants of benzylpenicillin were the most useful reagents. One fifth of the patients with penicillin hypersensitivity would have been missed if the major determinant of benzylpenicillin alone had been used for skin testing. The additional use of the minor determinants of other penicillin derivatives, however, did not increase substantially the clinical reliability of the skin testing procedure.
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Selected References
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- Abraham G. N., Petz L. D., Fudenberg H. H. Immunohaematological cross-allergenicity between penicillin and cephalothin in humans. Clin Exp Immunol. 1968 May;3(4):343–357. [PMC free article] [PubMed] [Google Scholar]
- Assem E. S., Vickers M. R. Tests for penicillin allergy in man. II. The immunological cross-reaction between penicillins and cephalosporins. Immunology. 1974 Aug;27(2):255–269. [PMC free article] [PubMed] [Google Scholar]
- Bierman C. W., Van Arsdel P. P., Jr Penicillin allergy in children: the role of immunological tests in its diagnosis. J Allergy. 1969 May;43(5):267–272. doi: 10.1016/0021-8707(69)90147-6. [DOI] [PubMed] [Google Scholar]
- FINKE S. R., GRIECO M. H., CONNELL J. T., SMITH E. C., SHERMAN W. B. RESULTS OF COMPARATIVE SKIN TESTS WITH PENICILLOYL-POLYLYSINE AND PENICILLIN IN PATIENTS WITH PENICILLIN ALLERGY. Am J Med. 1965 Jan;38:71–82. doi: 10.1016/0002-9343(65)90161-0. [DOI] [PubMed] [Google Scholar]
- Levine B. B. Antigenicity and cross-reactivity of penicillins and cephalosporins. J Infect Dis. 1973 Oct;128(Suppl):S364–S366. doi: 10.1093/infdis/128.supplement_2.s364. [DOI] [PubMed] [Google Scholar]
- Levine B. B., Redmond A. P., Fellner M. J., Voss H. E., Levytska V. Penicillin allergy and the heterogenous immune responses of man to benzylpenicillin. J Clin Invest. 1966 Dec;45(12):1895–1906. doi: 10.1172/JCI105494. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Levine B. B., Redmond A. P. Minor haptenic determinant-specific reagins of penicillin hypersensitivity in man. Int Arch Allergy Appl Immunol. 1969;35(5):445–455. doi: 10.1159/000230197. [DOI] [PubMed] [Google Scholar]
- Levine B. B., Zolov D. M. Prediction of penicillin allergy by immunological tests. J Allergy. 1969 Apr;43(4):231–244. doi: 10.1016/0021-8707(69)90066-5. [DOI] [PubMed] [Google Scholar]
- PARKER C. W., SHAPIRO J., KERN M., EISEN H. N. Hypersensitivity to penicillenic acid derivatives in human beings with penicillin allergy. J Exp Med. 1962 Apr 1;115:821–838. doi: 10.1084/jem.115.4.821. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Petz L. D. Immunologic reactions of humans to cephalosporins. Postgrad Med J. 1971 Feb;47(Suppl):64–69. [PubMed] [Google Scholar]
- Rosenblum A. H. Penicillin allergy. A report of thirteen cases of severe reactions. J Allergy. 1968 Dec;42(6):309–318. doi: 10.1016/0021-8707(68)90093-2. [DOI] [PubMed] [Google Scholar]
- Van Dellen R. G., Gleich G. J. Penicillin skin tests as predictive and diagnostic aids in penicillin allergy. Med Clin North Am. 1970 Jul;54(4):997–1007. [PubMed] [Google Scholar]
- Van Dellen R. G., Walsh W. E., Peters G. A., Gleich G. J. Differing patterns of wheal and flare skin reactivity in patients allergic to the penicillins. J Allergy. 1971 Apr;47(4):230–236. doi: 10.1016/s0091-6749(71)80468-2. [DOI] [PubMed] [Google Scholar]
- Wide L., Juhlin L. Detection of penicillin allergy of the immediate type by radioimmunoassay of reagins (IgE) to penicilloyl conjugates. Clin Allergy. 1971 Jun;1(2):171–177. doi: 10.1111/j.1365-2222.1971.tb03016.x. [DOI] [PubMed] [Google Scholar]