Use of commercial anti–penicillin IgE fluorometric enzyme immunoassays to diagnose penicillin allergy

Macy, Eric; Goldberg, Bruce; Poon, Kwun-Yee T.

doi:10.1016/j.anai.2010.06.014

Cited by 91 publications

(72 citation statements)

References 21 publications

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“…Since 2009, oral challenges are routinely done in all penicillin skin test-negative individuals at our medical center. 9 We administer oral challenges in response to the relatively high rate of new "allergy" associated with the initial penicillin-class antibiotic reuse in penicillin skin test-negative individuals, particularly females, as we document in this report. Because the challenge is part of the testing protocol, the primary care, or other treating physician does not have to deal with these reactions.…”

Section: Discussionmentioning

confidence: 97%

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Adverse Reactions Associated with Therapeutic Antibiotic Use after Penicillin Skin Testing

Macy¹,

Ho²

2011

TPJ

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IntroductionRecent reviews on adverse drug reactions note that only a small minority of the adverse reactions associated with antibiotic use are either IgE or T-cell mediated. 1,2The vast majority of antibiotic-associated adverse drug reactions, and, thus, drug "allergy" reports in the medical record, do not have an immunologic cause and their recurrence is not reliably predicted by immediate type hypersensitivity skin tests or oral challenges. Clinically, it is important to know both the incidence and expected severity of new adverse reactions associated with therapeutic antibiotic use in patients with a history of penicillin "allergy." It is important to have data on reactions associated with the use of both penicillins and nonpenicillin antibiotics, after both positive and negative penicillin skin testing, to make rational prescribing decisions.Decay of true IgE-mediated allergy over time does completely explain why historically less than 20%, and recently for our group less than 5%, of penicillin skin tests are positive.3 There may be less IgE sensitization to penicillin because of less parenteral penicillin use. Testing individuals who are not Allergy Department patients may also identify more individuals with nonIgE-mediated reactions. Resensitization, documented by a history of penicillin "allergy," an initial negative penicillin skin test, a reaction associated with a therapeutic penicillin use or challenge, and then a positive penicillin skin test, has been shown to be a rare event by our group and other investigators. 4-7Previously we reported on therapeutic antibioticassociated adverse reactions after penicillin skin testing in a relatively small, 249 patient, case-control study. 8 We noted adverse reaction rates of 3.2% to 5.4% per antibiotic course, comparing penicillin, cephalosporin, and other non-beta-lactam antibiotic use during three years of mean follow-up. Penicillin skin testing was only able to predict penicillin-associated adverse drug Abstract Background: There is little prospective data on the antibiotics prescribed and the adverse reactions associated with their use after penicillin skin testing.Objective: Provide data on antibiotic use and new antibiotic "allergy" incidence after penicillin skin testing.Methods: All patients who had penicillin skin testing at our Medical Center between 1-1-2000 and 12-31-2004 were followed through 12-31-2009. All therapeutic antibiotic use and all new "allergies" listed in their electronic medical records were reviewed.Results: There were 1684 study subjects of whom 1191 (70.7%) were female. There were 118 (7.0%) positive to at least one penicillin skin test reagent and 3 (0.2%) were positive only to amoxicillin. The mean follow-up period was 4.5 ± 2.9 years. Subjects were exposed to a mean of 8.2 ± 10.5 therapeutic antibiotic courses during follow-up. The highest new antibiotic "allergy" incidence rates in skin test-negative subjects were noted for penicillins, 2.9%, and sulfonamides, 2.7%, p = 0.9097. Females had higher overall incidences of new anti...

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Section: Discussionmentioning

confidence: 97%

“…The mean follow-up times were longer for the penicillin skin test-positive cohort because of the falling rate of positive penicillin skin tests that we have previously documented. 8,9 There were 787 (46.7%) study subjects who were still Health Plan members on December 31, 2009.…”

Section: Resultsmentioning

confidence: 99%

Adverse Reactions Associated with Therapeutic Antibiotic Use after Penicillin Skin Testing

Macy¹,

Ho²

2011

TPJ

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“…However, although previous trials suggested a moderate sensitivity for the diagnosis of immediate reactions to β-lactams, recent studies have failed to show such a diagnostic use in patients with remote histories of penicillin allergy [25,26,27,28]. …”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Immediate Hypersensitivity to β-Lactam Antibiotics Can Be Made Safely with Current Approaches

Çelik¹,

Aydın²,

Doğu³

et al. 2011

Int Arch Allergy Immunol

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Background: Diagnosing immediate hypersensitivity to β-lactam antibiotics is still a significant problem. Recently, a new penicillin testing reagent was introduced to the market. In this study, the recommendations of the European Network of Drug Allergy (ENDA) for the diagnosis of immediate reactions to β-lactams were followed, and the negative predictive value of this approach with currently available reagents was assessed. Methods: Eighty patients (age range: 6–74 years) with a history of immediate reactions to β-lactams were included. All cases underwent skin testing with benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM), followed by the culprit drug if necessary. If this step was negative, a drug provocation test was offered. If this step also yielded a negative result, then the patients were recommended to use β-lactam antibiotics in future whenever their use was indicated. Results: Overall, 29 patients (36.2%) were diagnosed as β-lactam allergic. The majority of the cases (72.4%) were diagnosed by positive skin tests to either PPL or MDM, whereas 10.3% were diagnosed by skin testing with culprit drugs and 17.2% with drug provocation tests. Regarding the use of the tested drug in the long term, almost half of the contacted patients had had an indication to use the tested drug and the majority had taken the whole course without problems. Conclusions: Although currently available new penicillin tests provide sufficient allergy data, all the steps recommended by ENDA should be followed in the diagnosis of immediate reactions to β-lactams. If these steps are negative, the patients usually tolerate β-lactams and only a few develop mild, non-life-threatening reactions in the long term.

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“…In this Spanish cohort of 290 patients with immediate reaction to a penicillin derivative, 40 patients were skin test negative and RAST positive and 24/40 skin testnegative patients had the RAST diagnosis confirmed by provocation [168]. Conversely, in a more recent prospective study of 150 patients with a history of penicillin allergy, none of the patients positive on oral challenge were positive by ImmunoCap [169]. Furthermore, positive specific IgE immunoassays for benzylpenicillin were reported from a series of amoxicillin-selective reactors who tolerated benzylpenicillin [85].…”

Section: Laboratory Investigationsmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

228

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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Use of commercial anti–penicillin IgE fluorometric enzyme immunoassays to diagnose penicillin allergy

Cited by 91 publications

References 21 publications

Adverse Reactions Associated with Therapeutic Antibiotic Use after Penicillin Skin Testing

Adverse Reactions Associated with Therapeutic Antibiotic Use after Penicillin Skin Testing

Diagnosis of Immediate Hypersensitivity to β-Lactam Antibiotics Can Be Made Safely with Current Approaches

Management of allergy to penicillins and other beta‐lactams

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