Desensitization of anaphylactic hypersensitivity specific for the penicilloate minor determinant of penicillin and carbenicillin

Gorevic, Peter D.; Levine, Bernard B.

doi:10.1016/0091-6749(81)90150-0

Cited by 36 publications

(4 citation statements)

References 40 publications

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“…If one uses fresh benzylpenicillin G (aged penicillin offers no advantage) [43], diluted to a concentration of 10 000 U/ml [10"-M], as the sole minor determinant, about 5 10% of skin-test reactive patients will be missed [41.24]. However, those missed may be at risk for serious., anaphylactic reactions [44]. The laek of access to a commercially available, minor determinant reagent has hindered the general application of penicillin skin testing for risk assessment.…”

Section: %mentioning

confidence: 99%

Immediate hypersensitivity reactions to penicillin and related antibiotics

Weiss

Adkinson

1988

Clin Experimental Allergy

314

212

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Section: %mentioning

confidence: 99%

Immediate hypersensitivity reactions to penicillin and related antibiotics

Weiss

Adkinson

1988

Clin Experimental Allergy

314

212

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“…Gadde et al [6] found that 90% of skin test-positive subjects demonstrated sensitivity to penicilloyl-polylysine, whereas 10% displayed sensitivity to the minor determinants alone. Testing sensitivity to the minor determinants is of particular importance given data suggesting that skin test reactivity to these antigens is clinically associated with more severe acute systemic reactions upon subsequent penicillin administration [6,13]. Inclusion of semisynthetic penicillins such as amoxicillin in penicillin allergy skin testing panels is not widely utilized [14], and data regarding its significance have not been extensively studied in the USA.…”

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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“…1.4-6 The importance of testing with minor deteminants has been emphasized in two recent large series 1.6 and a case report. 7 The major determinant (BPL) is commercially available, but skin-testing with BPL and freshly prepared penicillin, for example, may fail to detect patients with IgE antibodies to certain minor determinants. This is of special importance because patients with IgE antibodies to minor determinants are at risk for anaphylactic reactions.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Venereal Disease in the Penicillin-Allergic Patient: Administration of Penicillin following testing with Major and Minor Determinants

Greenberger

Phair

1985

allergy asthma proc

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We describe the administration of penicillin for venereal disease in three penicillin-allergic patientsfor whom alternative ant ibiotics were not considered suitable. Each patient was skin test negative to the major penicillin determinant benzylpenicilloyl-pofFfFsine and a minor determinant mixture of potassium penicillin, benzylpenicilloate and benzylpenicilloyl-n-propylamine provided by the National Institute of A lIergy and Infectious Diseases. Therapeutic doses ofpenicillin were administered without anaphylaxis, but one patient developed serum sickness on day fi"ve following benzylpenicillin.The skin testing results were determined within 30 minutes such that penicillin or its derivatives could be administered safef)' and rapidfF to seriouslF ill patients, i.e. disseminated gonococcemia. When treating neurosyphilis or disseminated gonococcal infection for which non-penicillin therapy is unacceptable. use of the current skin test reagents provides a level of safety in avoiding anaphylaxis not previously allainable.

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Desensitization of anaphylactic hypersensitivity specific for the penicilloate minor determinant of penicillin and carbenicillin

Cited by 36 publications

References 40 publications

Immediate hypersensitivity reactions to penicillin and related antibiotics

Immediate hypersensitivity reactions to penicillin and related antibiotics

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

Treatment of Venereal Disease in the Penicillin-Allergic Patient: Administration of Penicillin following testing with Major and Minor Determinants

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