Clinical approach to penicillin-allergic patients: a survey

Solensky, Roland; Earl, Harry S.; Gruchalla, Rebecca S.

doi:10.1016/s1081-1206(10)62782-2

Cited by 87 publications

(60 citation statements)

References 18 publications

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“…The commonest drug allergens are penicillin class antibiotics and cephalosporin (which cross-react) [14], curare-like muscle relaxants [15]and iodine-containing contrast media [16]. Intracutaneous prick tests can be used to assist in confirmation of diagnosis but have only been validated in the case of penicillin allergy [17, 18, 19]. Immunoassays are commercially available but their predictive validity has not been substantiated [20].…”

Section: Drug Allergy As a Cause Of Urticariamentioning

confidence: 99%

Drug-Induced Urticaria and Angioedema: Pathomechanisms and Frequencies in a Developing Country and in Developed Countries

Greaves

Hussein²

2002

Int Arch Allergy Immunol

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A careful drug history should be obtained from all patients with acute or chronic urticaria/angioedema, especially in the elderly. Although strictly comparable data are lacking, drug-induced urticaria appears to be more common in developed countries than in Malaysia, at least in a Hospital setting. Culprit drugs include antibiotics, analgesics and contrast media. Pseudoallergic drug-induced urticaria mimicks true allergic urticaria, but without an evident immunological basis, and is at least as common as the allergic type. In Malaysia, and in many other countries compulsory, ingredient labelling of ‘traditional’ medicines would do much to reduce the frequency of drug-induced urticaria.

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Section: Drug Allergy As a Cause Of Urticariamentioning

confidence: 99%

Drug-Induced Urticaria and Angioedema: Pathomechanisms and Frequencies in a Developing Country and in Developed Countries

Greaves

Hussein²

2002

Int Arch Allergy Immunol

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“…The negative consequences of this mislabeling include limited antibiotic options, the unnecessary use of broad-spectrum antibiotics, increased risk of toxicity and increased healthcare costs [9,10]. Thus, the role of penicillin skin testing (PST) is important in evaluating true penicillin allergy in order to optimize the efficacy of medical care [11]. However, there are currently no standardized guidelines regarding which determinants to include in a PST panel.…”

Section: Introductionmentioning

confidence: 99%

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

Lin¹,

Saxon²,

Riedl³

2010

Int Arch Allergy Immunol

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Background: Allergy to penicillins remains an important issue. Penicillin skin testing (PST) with major and minor determinants has been shown to be a highly valuable tool for identifying IgE-mediated penicillin allergy. The value of additional testing with side-chain-specific moieties from semisynthetic penicillins such as amoxicillin is not well-established in spite of the widespread use of these medications. Methods: A retrospective review of all consecutive inpatient PST results from 1995 to 2007 comprising 1,068 patients was performed in our institution on individuals with a self-reported history of beta-lactam allergy to assess the importance of including the amoxicillin determinant in a previously validated PST panel. Descriptive statistics were performed. The PST panel included penicilloyl-polylysine, penicillin G, penicilloate, penilloate and amoxicillin. Results: Of 1,068 patients, 243 (23%) had a positive skin test reaction on the PST panel. Testing with amoxicillin was positive in 30.9% of patients, the majority of whom (81%) were also positive to 1 or more standard penicillin reagents. Fourteen of the 243 positive patients (5.8%) had a positive skin test reaction only to amoxicillin. Additionally, the use of penicilloate and penilloate minor determinants in combination with penicillin G identified a greater percentage of penicillin-allergic individuals compared to using only penicillin G (22.6 vs. 6.6%), demonstrating their importance in the PST panel. Conclusions: These data indicate that the inclusion of the amoxicillin determinant appears to identify a small but important group of allergic individuals who may otherwise test negative on a PST panel.

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“…Moreover, allergic reactions increase expenses for treatment of patients [4,8]. Clinicians do not often resolve to prescribe antibiotics to patients with suspected, though unconfirmed IgE-mediated reactions due to a potential risk of development of life-threatening anaphylactic reactions [9]. The aim of this article is the review of an issue of allergic reactions to antibiotics in pediatric practice and review of clinical approaches to the management of patients with suspected intolerance to antibacterial drugs.…”

Section: Introductionmentioning

confidence: 99%