Positive Skin Test or Specific IgE to Penicillin Does Not Reliably Predict Penicillin Allergy

Tannert, Line Kring; Mørtz, Charlotte G.; Skov, Per Stahl; Bindslev‐Jensen, Carsten

doi:10.1016/j.jaip.2017.03.014

Cited by 38 publications

(24 citation statements)

References 35 publications

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“…All penicillin-allergic patients included in this study had a previous positive ICT to penicillin, but only 10 of 21 patients had a positive ICT to penicillin when entering the study 3–30 months after the initial positive ICT. This is in line with other studies describing declining rates of positive ICTs over time [ 4 , 5 , 23 , 24 ]. In contrast, three patients (Patient 11–13, Table 1 ) showed a dual ICT response with an immediate reaction followed hours later by a delayed reaction that was persistently positive in our study, which is in agreement with data from Hjortlund et al [ 17 ].…”

Section: Discussionsupporting

confidence: 93%

Is a positive intracutaneous test induced by penicillin mediated by histamine? A cutaneous microdialysis study in penicillin-allergic patients

Tannert

Falkencrone²,

Mørtz

et al. 2017

Clin Transl Allergy

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BackgroundDiagnostic workup of penicillin allergy comprises skin testing with penicillins, and patients are deemed allergic if skin test is positive. However, the literature suggests that skin test-positive patients may be challenge-negative, indicating that the skin test may be falsely positive.ObjectiveTo investigate real-time histamine release from a positive intracutaneous test induced by penicillin in patients with positive and negative challenges to penicillin.MethodsSkin microdialysis was performed in 21 penicillin-allergic patients with positive skin test, 13 non-allergic volunteers serving as negative controls, and 7 grass pollen-allergic patients serving as positive controls. Histamine was measured by microdialysis after skin test with penicillin/grass/NaCl. Penicillin challenge was subsequently performed in 12 of the patients.ResultsOnly 10/21 patients (47.6%) were skin test positive at microdialysis. During microdialysis 13 single intracutaneous tests were positive and histamine was detected in 4/13 occurring in four challenge positive patients. Thirteen/21 patients (61.9%) were deemed allergic to penicillin; eight had positive skin test. Two patients with positive skin test were challenge negative. In grass pollen allergic patients, 7/7 had a positive intracutaneous test to grass and all released histamine in the wheals. All 13 negative controls had negative intracutaneous test to penicillin and no histamine release.ConclusionHistamine was only detected in the minority of positive intracutaneous tests with penicillin in penicillin-allergic patients. Other mediators may be involved.

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Section: Discussionsupporting

confidence: 93%

Is a positive intracutaneous test induced by penicillin mediated by histamine? A cutaneous microdialysis study in penicillin-allergic patients

Tannert

Falkencrone²,

Mørtz

et al. 2017

Clin Transl Allergy

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“…93 Skin testing for penicillin allergy has long been known to add additional predictive utility for immediate hypersensitivity over clinical history alone. 17,100 In those with a history of highrisk reactions (eg, widespread immediate urticaria upon first dose, anaphylaxis), skin testing has been successfully deployed to improve point-of-care prescribing, including in the intensive that demonstrated an increase in penicillin utilization (9.9%-49%) and decrease in vancomycin and fluoroquinolone usage after skin testing. 80 Heil et al demonstrated that an infectious disease led testing service facilitated narrow-spectrum antibiotic selection in an additional 63% of patients.…”

Section: Patients With a Low-risk History Or A History Inconsistent Wmentioning

confidence: 99%

The challenge of de‐labeling penicillin allergy

Stone

Trubiano

Coleman

et al. 2019

Allergy

187

160

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Background Even though 8%‐25% of most populations studied globally are labeled as penicillin allergic, most diagnoses of penicillin allergy are made in childhood and relate to events that are either not allergic in nature, are low risk for immediate hypersensitivity, or are a potential true allergy that has waned over time. Penicillin allergy labels directly impact antimicrobial stewardship by leading to use of less effective and broader spectrum antimicrobials and are associated with antimicrobial resistance. They may also delay appropriate antimicrobial therapy and lead to increased risk of specific adverse healthcare outcomes. Operationalizing penicillin allergy de‐labeling into a new arm of antimicrobial stewardship programs (ASPs) has become an increasing global focus. Methods We performed an evidence‐based narrative review of the literature of penicillin allergy label carriage, the adverse effects of penicillin allergy labels, and current approaches and barriers to penicillin allergy de‐labeling. Over the period 1928‐2018 in Pubmed and Medline, search terms used included “penicillin allergy” or “penicillin hypersensitivity” alone or in combination with “adverse events,” “testing,” “evaluation,” “effects,” “label,” “de‐labeling,” “prick or epicutaneous,” and “intradermal” skin testing, “oral challenge or provocation,” “cross‐reactivity,” and “antimicrobial stewardship”. Results Penicillin allergy labels are highly prevalent, largely inaccurate and their carriage may lead to unnecessary treatment and inferior outcomes with alternative agents as well as adverse public health outcomes such as antibiotic resistance. Conclusions Operationalizing penicillin allergy de‐labeling as an aspect of ASP has become an increasing global focus. There is a need for validated approaches that optimally combine the use of history and ingestion challenge with or without proceeding formal skin testing to tackle penicillin allergy efficiently within complex healthcare systems. At the same time, there is great promise for penicillin allergy evaluation and de‐labeling as an individual and public health strategy to reduce adverse healthcare outcomes, improve antimicrobial stewardship, and decrease healthcare costs.

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“…Although ssIgE to different drugs can be measured, clear evidence to justify their use in the diagnosis of IgE-mediated drug allergies is lacking, because results do not correlate with the outcomes of drug challenges [ 64 ]. However, penicillin-specific IgE may be useful in patients with recent anaphylaxis to penicillin [ 65 ].…”

Section: Part 3: Elevated Ige a Biomarker In Allergiesmentioning

confidence: 99%

AllergoOncology: ultra-low IgE, a potential novel biomarker in cancer—a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI)

Ferastraoaru

Bax

Bergmann³

et al. 2020

Clin Transl Allergy

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Elevated serum IgE levels are associated with allergic disorders, parasitosis and specific immunologic abnormalities. In addition, epidemiological and mechanistic evidence indicates an association between IgE-mediated immune surveillance and protection from tumour growth. Intriguingly, recent studies reveal a correlation between IgE deficiency and increased malignancy risk. This is the first review discussing IgE levels and links to pathological conditions, with special focus on the potential clinical significance of ultra-low serum IgE levels and risk of malignancy. In this Position Paper we discuss: (a) the utility of measuring total IgE levels in the management of allergies, parasitosis, and immunodeficiencies, (b) factors that may influence serum IgE levels, (c) IgE as a marker of different disorders, and d) the relationship between ultra-low IgE levels and malignancy susceptibility. While elevated serum IgE is generally associated with allergic/atopic conditions, very low or absent IgE may hamper anti-tumour surveillance, indicating the importance of a balanced IgE-mediated immune function. Ultra-low IgE may prove to be an unexpected biomarker for cancer risk. Nevertheless, given the early stage of investigations conducted mostly in patients with diseases that influence IgE levels, in-depth mechanistic studies and stratification of malignancy risk based on associated demographic, immunological and clinical co-factors are warranted.

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Positive Skin Test or Specific IgE to Penicillin Does Not Reliably Predict Penicillin Allergy

Cited by 38 publications

References 35 publications

Is a positive intracutaneous test induced by penicillin mediated by histamine? A cutaneous microdialysis study in penicillin-allergic patients

Is a positive intracutaneous test induced by penicillin mediated by histamine? A cutaneous microdialysis study in penicillin-allergic patients

The challenge of de‐labeling penicillin allergy

AllergoOncology: ultra-low IgE, a potential novel biomarker in cancer—a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI)

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