Determination of IgE antibodies to the benzylpenicilloyl determinant: A comparison of the sensitivity and specificity of three radio allergo sorbent test methods

Garcı́a, J.J.; Blanca, Miguel; Moreno, F.; Vega, José M.; Mayorga, Cristobalina; Fernández, J.; Juárez, C.; Romano, Antonino; Enrique, Rafael

doi:10.1002/(sici)1098-2825(1997)11:5<251::aid-jcla3>3.0.co;2-a

Cited by 49 publications

(24 citation statements)

References 35 publications

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“…In vitro testing for the major determinant is also available, but its negative predictive value is less well established and is less compared with immediate hypersensitivity testing. 140 Skin testing with penicillin derivatives or cephalosporins is not as well studied. Maximum testing concentrations of 1 to 3 mg/mL have been suggested for these other b-lactams.…”

Section: Anaphylaxis During General Anesthesia the Intraoperative Pementioning

confidence: 99%

The diagnosis and management of anaphylaxis: An updated practice parameter

Lieberman¹,

Kemp²,

Oppenheimer³

et al. 2005

Journal of Allergy and Clinical Immunology

459

254

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Section: Anaphylaxis During General Anesthesia the Intraoperative Pementioning

confidence: 99%

The diagnosis and management of anaphylaxis: An updated practice parameter

Lieberman¹,

Kemp²,

Oppenheimer³

et al. 2005

Journal of Allergy and Clinical Immunology

459

254

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“…In vitro assays to quantify sIgE for several penicillin determinants (Phadia penicilloyl G (c1), penicilloyl V (c2), amoxycilloyl (c6), ampicilloyl (c5) and cefaclor (c7)) are available and, although generally less sensitive than skin tests, constitute a valuable and safe tool in the diagnostic approach for patients with suspected IgEmediated b-lactam allergy (90)(91)(92)(93).…”

Section: Antibioticsmentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

193

197

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Anaesthesiologists administer several drugs while providing general anaesthesia. Many of these drugs can elicit adverse drug reactions that fall apart into two major types. First, reactions that are usually dose-dependent and related to the pharmacological properties of the drug and/or its metabolites. Second, reactions that are unrelated to the drug's pharmacological characteristics and that are less dose-dependent. These reactions comprise drug intolerance, idiosyncratic reactions and drug-induced immune-mediated allergic and nonimmune-mediated so-called pseudo-allergic or anaphylactoid reactions. The terms anaphylactic and anaphylactoid, however, have been used inconsistently in the literature. Therefore, the nomenclature task force set up by the European Academy of Allergy and Immunology (EAACI) has proposed that anaphylactic-type reactions should be reclassified into allergic anaphylaxis and nonallergic anaphylaxis. Allergic anaphylaxis being further subdivided in IgE-mediated and non-IgE-mediated reactions (1).The exact prevalence of anaphylaxis during anaesthesia is difficult to ascertain. The estimated overall frequency has been reported to vary between 1 in 3500 and 1 in 13 000 procedures in French series (2, 3) and between 1 in 10 000 and 1 in 20 000 in an Australian study (4). The clinical manifestation of these reactions is not infrequently an almost immediate generalized response with bronchospasm and hypotension. The degree of severity varies and does not allow differentiation between an IgE-mediated or non-IgE mediated reaction resulting from nonspecific mediator release (5). The mortality from these reactions is in the range from 3 to 6%, and an additional 2% of patients experience significant residual brain damage (4).Diagnosis of anaphylaxis during anaesthesia is not always straightforward. It can be hampered as a broad spectrum of different drugs can elicit heterogeneous allergic and nonallergic reactions with distinct and sometimes unclear pathological mechanisms. Problems are certainly compounded as multiple drugs need to be administered during general anaesthesia. In addition, nonanaesthesia related drugs or procedures (e.g. disinfection) are sometimes administered/performed in the perioperative period and can also be the cause of an allergic reaction.In addition, none of the available diagnostic tests demonstrates absolute accuracy. False-positive test Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anaesthesiologist, and subsequent determination of the responsible agent(s) with strict avoidance of subsequent administration of all incriminated and/or cross-reacting compounds.However, correct identification of the causative compound(s) and safe alternatives is not always straightforward and, too often, not done.This review is not intended to discuss acute management of anaesthesia-related anaphylaxis but summarizes the major causes of anaphylaxis during anaesthesia and the di...

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“…Again, these tests are available mainly for penicillins and cephalosporins. Radioimmunoassays previously used mainly for the diagnosis of penicillin allergy (including the radioallergosorbent test, RAST) have over the years been replaced with the FEIA assays 16,17. Flow-cytometric based basophil activation tests (BAT) (flow assay stimulation test, FAST/FlowCAST®, Buhlmann Laboratories) which measure CD69 or CD203c on drug-specific activated basophils may have a role in the diagnosis of antibiotic allergy, with studies so far mainly focused on beta-lactam allergy 18…”

Section: Diagnosis Of Antibiotic Allergymentioning

confidence: 99%

Update on the Management of Antibiotic Allergy

Thong

2010

Allergy Asthma Immunol Res

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Drug allergy to antibiotics may occur in the form of immediate or non-immediate (delayed) hypersensitivity reactions. Immediate reactions are usually IgE-mediated whereas non-immediate hypersensitivity reactions are usually non-IgE or T-cell mediated. The clinical manifestations of antibiotic allergy may be cutaneous, organ-specific (e.g., blood dyscracias, hepatitis, interstitial nephritis), systemic (e.g., anaphylaxis, drug induced hypersensitivity syndrome) or various combinations of these. Severe cutaneous adverse reactions manifesting as Stevens Johnson syndrome or toxic epidermal necrolysis (TEN) may be potentially life-threatening. The management of antibiotic allergy begins with the identification of the putative antibiotic from a detailed and accurate drug history, complemented by validated in-vivo and in-vitro allergological tests. This will facilitate avoidance of the putative antibiotic through patient education, use of drug alert cards, and electronic medical records with in-built drug allergy/adverse drug reaction prescription and dispensing checks. Knowledge of the evidence for specific antibiotic cross-reactivities is also important in patient education. Apart from withdrawal of the putative antibiotic, immunomodulatory agents like high-dose intravenous immunoglobulins may have a role in TEN. Drug desensitization where the benefits outweigh the risks, and where no alternative antibiotics can be used for various reasons, may be considered in certain situations. Allergological issues pertaining to electronic drug allergy alerts, computerized physician prescriptions and decision support systems, and antibiotic de-escalation in antimicrobial stewardship programmes are also discussed.

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Determination of IgE antibodies to the benzylpenicilloyl determinant: A comparison of the sensitivity and specificity of three radio allergo sorbent test methods

Cited by 49 publications

References 35 publications

The diagnosis and management of anaphylaxis: An updated practice parameter

The diagnosis and management of anaphylaxis: An updated practice parameter

Anaphylaxis during anaesthesia: diagnostic approach

Update on the Management of Antibiotic Allergy

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