New Aspects on Antigens in Penicillin Allergyss

Ahlstedt, S.; Ekström, Bertil; Svärd, P.O.; Sjöberg, Berndt; Kristofferson, A.; Örtengren, B.; Weck, A.L. de

doi:10.3109/10408448009032925

Cited by 31 publications

(12 citation statements)

References 143 publications

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“…This discrepancy could be due to the use of ampi cillin preparations of higher purity in the present study than in the previous ones. The more accentuat ed response reflected in the RIA measurements, as compared with those of the other methods, might be due to the formation of penicilloylated antigen effi ciently detected by the RIA [1,6,11]. The presence of monovalent penicillin may also have an effect on the measurements, however [10].…”

Section: Discussionmentioning

confidence: 99%

“…Instead, the small increases noted may have been part of a po lyclonal antibody formation stimulated by the infect ing bacteria. Such an impact of micro-organisms on the levels of penicilloyl-specific IgM antibodies has been noted in mice exposed to Bordetella pertussis bacteria [1,9].…”

Section: Discussionmentioning

confidence: 99%

“…The presence of monovalent penicillin may also have an effect on the measurements, however [10]. Antigen formed during therapy by penicillin conjugation to body proteins has never been proven immunogenic [1,4], and the slight increase in IgM antibody levels noted is not likely to have been induced by such antigens. Instead, the small increases noted may have been part of a po lyclonal antibody formation stimulated by the infect ing bacteria.…”

Section: Discussionmentioning

confidence: 99%

“…Antibodies against penicillin and its derivatives, in particular the penicilloyl group, have been demon strated in patients with penicillin allergy [i. a., 1,6]. Infants receiving penicillin at birth and later on have previously been shown to have penicilloyl-specific antibodies in their serum [7], From experimental stud ies in mice [1,4,9] and rabbits [5], impurities in the preparations have been demonstrated to be the most likely inducing antigen.…”

Section: Introductionmentioning

confidence: 99%

“…Infants receiving penicillin at birth and later on have previously been shown to have penicilloyl-specific antibodies in their serum [7], From experimental stud ies in mice [1,4,9] and rabbits [5], impurities in the preparations have been demonstrated to be the most likely inducing antigen. Thus, the observed pattern may have been affected by the purity of the drug prep aration used and also by the total exposure to penicil lin, e. g. in contaminated food.…”

Section: Introductionmentioning

confidence: 99%

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Antibody Responses to Impurities of Penicillin in Infants and Rabbits

Ahlstedt¹,

Jodal²,

Mårild³

et al. 1982

Int Arch Allergy Immunol

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Antibody responses to penicilloyl were recorded in infants and children treated for about 1 week with intravenous ampicillin. In this single-blind, randomized study two commercially available preparations were compared, one of high-grade purity (< 0.1 μg antigen per gram) and the other slightly contaminated with high molecular weight proteinaceous material (1.5 μg antigen per gram) according to a radioimmunoassay. The results showed no significant increase in the antibody titers in any of the patient groups. The immunogenic properties of high molecular weight proteinaceous impurities isolated from phenoxymethyl penicillin during manufacture were tested in rabbits given daily subcutaneous injections with 0.1–10 μg of the antigen over 10-day periods. When the 10-day period was repeated, the rabbits injected with more than 2 μg of antigen responded with both IgM/IgG and IgE antibodies. The clinical as well as the animal study indicates that antigen impurities in the preparations of the order of 2 μg per gram or less do not elicit a significant antibody response. However, the study in rabbits demonstrates that high molecular weight impurities can induce penicillin allergy if present in about 10-fold higher quantities than those usually found in the commercial penicillin preparations of today.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Antibody Responses to Impurities of Penicillin in Infants and Rabbits

Ahlstedt¹,

Jodal²,

Mårild³

et al. 1982

Int Arch Allergy Immunol

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Oral Desensitization for Penicillin Sensitivity

Stark¹,

Wendel²,

Sullivan³

1987

JAMA

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Oral Desensitization forPenicillin Sensitivity To the Editor.\p=m-\Inthe recent report of a successful parenteral desensitization of a pregnant, penicillin-allergic woman with syphilis, Ziaya and colleagues1 proposed that parenteral desensitization is preferable to the more widely studied oral desensitization method.2-4 Fatal and near-fatal anaphylactic reactions during parenteral desensitization are well doc-umented2 and should have been considered more carefully.Four important considerations suggest that oral desensitization is safer.First, deaths from orally administered penicillins are exceedingly rare.2 In one large study, all of 72 fatal anaphylactic reactions to penicillin were induced by parenteral therapy,5 despite the more prevalent use of oral therapy. Second, the drug polymers and penicillin-mold protein conjugates that contaminate therapeutic materials, thought to be important elicitors of anaphylaxis,6 would not be expected to be absorbed after oral administration. Third, blood levels gradually rise after oral administration, favoring univalent (harmless) conjugation, in contrast to the locally very high concentrations at sites of parenteral administration.2 Finally and most important, no life-endangering re¬ actions have occurred in our experience or in the cases reported by others (more than 90 cases of oral desensitization).2"4In our opinion, existing data favor oral desensitization. The apparent ad¬ vantage of being able to halt parenteral desensitization quickly is balanced by a significant risk of urgently needing to do so.2In addition, our study of 13 pregnant, penicillin-allergic patients with syphilis indicated that oral desensitization fol¬ lowed by conventional therapy with in¬ tramuscular penicillin G benzathine was routinely successful.4 Prolonged hospitalization as described by the authors does not appear to be required to treat infections of this kind.

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β‐Lactam Antibiotics

Andreotti

Biondi

Modugno

2003

Burger's Medicinal Chemistry and Drug Discovery

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This chapter reviews the history of β‐lactams from the discovery of penicillin in 1928 to the more recently studied and the current trends in the field. The most relevant aspects related to the mechanism of action of β‐lactams are covered, and the various mechanisms of resistance to currently available β‐lactams that bacteria have adopted since the introduction of penicillin are described. A classification of β‐lactamases and their relevance in clinics is also provided. Applications of β‐lactams both in the hospital and in the community are reported, with particular attention to their pharmacokinetic properties, related side effects, and their therapeutic indications. The history and discovery of β‐lactams are described and all major classes are covered: penicillins, cephalosporins, oxacephems, carbacephems, penems, monobactams and nocardicins, carbapenems and trinems, classical (e.g., clavulanic acid, sulbactam, tazobactam), and the more recently disclosed β‐lactamase inhibitors. Several aspects related to the most recent developments in β‐lactams are also covered: new molecules active against difficult Gram‐positive strains or endowed with an antibacterial broad spectrum of action; potent orally active β‐lactams; injectable β‐lactams; and β‐lactamase inhibitors. The chapter concludes with a continuing analysis of the industry‐driven trends and the most recent new application of β‐lactams as inhibitors of protein export in bacteria. Finally, a few very interesting Web addresses and a comprehensive reference list are also provided.

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New Aspects on Antigens in Penicillin Allergyss

Cited by 31 publications

References 143 publications

Antibody Responses to Impurities of Penicillin in Infants and Rabbits

Antibody Responses to Impurities of Penicillin in Infants and Rabbits

Oral Desensitization for Penicillin Sensitivity

β‐Lactam Antibiotics

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