Antibodies to penicillin in children receiving long‐term secondary prophylaxis for rheumatic fever

Abstract

The occurrence of IgE and IgG antibodies to penicillin G and V in children on long-term treatment with penicillin as secondary prophylaxis for rheumatic fever was studied using Phadebas RAST (Pharmacia Diagnostics, Uppsala, Sweden) and ELISA respectively. The duration of the prophylaxis ranged between 1.5 months and 5 years (mean 1.8 years). Of 18 patients who had been given penicillin for more than 1.5 months, two had IgE antibodies and 12 had IgG antibodies to penicillin. Patients with acute rheumatic fever who had not yet received long-term treatment with penicillin had antibodies of the IgG class in two out of 12 cases. The patients gave no history of adverse reactions to the penicillin injections and there were no signs of immune complex-mediated disease. The two children who had IgE antibodies were switched to oral erythromycin instead of the penicillin injections. Penicillin is the drug of choice in the prophylaxis of rheumatic fever and can apparently be safely given as intramuscular injections of depot-penicillin to prevent recurrences of the disease and ensuing cardiac damage.

Immunologic response to different determinants of benzylpenicillin, amoxicillin, and ampicillin. Comparison between urticaria and anaphylactic shock

“…It has also been suggested that they may be able to prevent anaphylactic shock in penicillin‐allergic subjects by their blocking ability ( 3). IgG antibodies to penicillin have been studied by different authors using different methods and with variable results ( 24–26). Levine et al observed that 100% of subjects receiving penicillins developed IgG antibodies ( 14).…”

Do In Vitro Assays Predict Drug Candidate Idiosyncratic Drug-Induced Liver Injury Risk?

“…Although most patients do not have a clinically evident IDR when treated with a drug, there may be an immune response. For example, most patients who are treated with penicillin develop antipenicillin antibodies but in most cases they are IgG antibodies and there is no adverse reaction (Strannegård et al, 1987). Furthermore, almost all patients treated with procainamide for an extended period of time develop autoantibodies, but most do not develop a clinical autoimmune syndrome (Woosley et al, 1978).…”

Immediate Hypersensitivity Reactions to Penicillins and Other Betalactams

“…Nevertheless, a considerable overlap exists between immediate and accelerated reactions and the latter are very often classified as immediate reactions, contributing to their misclassification. Mechanisms involving an IgE mediated response have been proposed for serum sickness and delayed urticaria, though current knowledge is insufficient to confirm this [18][19][20][21]. However, a detailed analysis of this is beyond the scope of this review, although it is nevertheless an interesting hypothesis.…”