Skin testing with penicilloate and penilloate prepared by an improved method: Amoxicillin oral challenge in patients with negative skin test responses to penicillin reagents

Macy, Eric; Richter, Paul Kenneth; Falkoff, Reuben; Zeiger, Robert S.

doi:10.1016/s0091-6749(97)70159-3

Cited by 102 publications

(70 citation statements)

References 8 publications

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“…12,[14][15][16][17][18][19] Study cohort demographics are reported in Table 1. Of 3469 study subjects tested, 255 had positive results on PenSTs.…”

Section: Resultsmentioning

confidence: 99%

“…12 Commercially produced PPL (Pre-Pen) became unavailable in the US after September 2004. Penicillin skin testing was done between October 2004 and October 2006 using outdated Pre-Pen, as previously reported.…”

Section: Penicillin Skin Test Reagentsmentioning

confidence: 99%

“…12,15 Almost all patients with a negative result after July 16, 2006, were given an oral amoxicillin (250 mg) or penicillin (500 mg) challenge and observed for one hour.…”

Section: Oral Challengesmentioning

confidence: 99%

See 2 more Smart Citations

The Falling Rate of Positive Penicillin Skin Tests from 1995 to 2007

Macy¹,

Schatz²,

Lin³

et al. 2009

TPJ

Self Cite

107

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Background: Data on the rate of positive penicillin skin test (PenST) results over time in large populations are rare. The factors that influence positive PenST results are incompletely understood.Objectives: We sought to correlate demographic variables to the rate of positive PenST results over time in a large group of patients with a history of penicillin allergy. Methods:Results from the first test for all patients tested for penicillin allergy in the Kaiser Permanente Health Care Program in San Diego County, CA, between 1995 and 2007 are reported. All patients were tested with penicillin, penicilloyl-poly-lysine, penilloate, penicilloate, and amoxicillin.Results: There were 255 positive PenST results in 3469 individuals. The rate of positive PenST results declined from >10% to <5% during the 13 years studied. The positive PenST result rate could be accounted for by the year of testing (R 2 = 0.56; p = 0.003) without any significant contribution from the patient's age or the time since reaction (TSR). If the TSR was ≤13 years, the relative risk of a positive PenST result was 2.1 (95% confidence interval = 1.6-2.8). If the study subject's age was ≤38 years, the relative risk of a positive PenST result was 2.1 (95% confidence interval = 1.6-2.7). Females reported higher rates of penicillin allergy history than males did (11% compared with 6.6%; p < 0.0001), but there were no significant sex differences in the rate of positive PenST results.Conclusions: There has been a steady decline in the proportion of positive PenST results between 1995 and 2007, independent of study subject age and TSR. Increasing age and increasing TSR were associated with a lower rate of positive PenST results. Eric Macy, MD, (top, left) is an Allergist in the

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“…12,[14][15][16][17][18][19] Study cohort demographics are reported in Table 1. Of 3469 study subjects tested, 255 had positive results on PenSTs.…”

Section: Resultsmentioning

confidence: 99%

Section: Penicillin Skin Test Reagentsmentioning

confidence: 99%

See 1 more Smart Citation

The Falling Rate of Positive Penicillin Skin Tests from 1995 to 2007

Macy¹,

Schatz²,

Lin³

et al. 2009

TPJ

Self Cite

107

View full text Add to dashboard Cite

show abstract

“…Once administered, penicillin undergoes spontaneous degradation because of a chemically unstable b-lactam ring, forming reactive intermediate products which can bind to lysine residue aminogroups on soluble or cell-bound proteins [13,78,79]. This results in the formation of benzyl penicilloyl, the major antigenic determinant of penicillin against which the majority of allergic patients react [80,81].…”

Section: Molecular Structurementioning

confidence: 99%

“…Early studies estimated that omitting penicillin G, penicilloic acid and penicilloyl-poly-L-lysine would lead to non-detection of 13.4% of positive cases [104]. Furthermore, an early study by Macy and colleagues [80] found that up to 20% of patients were only positive to minor determinants (penilloate and penicilloate). The importance of including both PPL and MDM determinants has been confirmed in two series of patients with hypersensitivity reactions to beta-lactams [81,123].…”

Section: Skin Test Reagentsmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Lack of Penicillin Resensitization in Patients With a History of Penicillin Allergy After Receiving Repeated Penicillin Courses

Solensky

Earl

Gruchalla³

2002

Arch Intern Med

157

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Adult patients with a history of penicillin allergy are not at increased risk of resensitization after receiving 3 courses of oral penicillin. Because a negative penicillin skin test result is predictive for subsequent oral administrations beyond the time of testing, adult patients with a history of penicillin allergy can be skin tested electively, which may avoid unnecessary treatment with alternate broad-spectrum antibiotics.

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Skin testing with penicilloate and penilloate prepared by an improved method: Amoxicillin oral challenge in patients with negative skin test responses to penicillin reagents

Cited by 102 publications

References 8 publications

The Falling Rate of Positive Penicillin Skin Tests from 1995 to 2007

The Falling Rate of Positive Penicillin Skin Tests from 1995 to 2007

Management of allergy to penicillins and other beta‐lactams

Lack of Penicillin Resensitization in Patients With a History of Penicillin Allergy After Receiving Repeated Penicillin Courses

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