Diagnosis of penicillin allergy by means of Phadebas RAST® penicilloyl G and V and skin tests

Abstract

Summary Fifty patients with suspected allergy to penicillin were tested. Skin tests were done with Na‐penicillin G and penicilloyl‐polylysin. Specific IgE antibody assays were done with penicilloyl G and V conjugates by means of RAST. The overall agreement between skin test and RAST results was 87%, borderline cases not included. In one case, skin tests were positive to penicillamine only, while RAST for penicilloyl G and V both proved to be positive. One case of penicillin allergy could be diagnosed in vitro post mortem only. Two cases of Hoigné syndrome showed no evidence of allergy. Patterns of skin manifestations varied but urticaria was the most commonly seen feature. Twenty patients without adverse reactions to penicillin treatment and seven patients who had not received penicillin over the last 10 years served as controls. None of them were positive in either skin tests or RAST. Two of our twenty control patients developed penicillin allergy during the study. Both showed positive RAST results.

Side Chain-Specific Lymphocyte Responses in Workers with Occupational Allergy Induced by Penicillins

“…Penicillininduced human IgE antibodies are at least partly spe cific for side chains of the penicillin molecule. Thus, several patients were positive in penicilloyl V RAST but negative in penicilloyl G RAST [11], The impor tance of minor determinants in penicillin allergy is supported by the results of this communication. The side chain-specific lymphocyte and skin response in allergic workers seems to exclude the penicilloyl group as the major antigenic determinant relevant to occupational penicillin sensitization.…”

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

“…In addition, RAST inhibition has proved to be a useful tool for defining the specificity of IgE antibodies and studying the cross-reactivity with other betalactams (26,35). The assay that we describe is a classical RAST method where discs were activated with cyanogen bromide as reported elsewhere (6,7,8,10). In two of the assays, in a first step discs were conjugated to the spacer (PLL and SP) and in the BPO-HSA assay optimal conjugates of the hapten with the carrier were first made and in a second step these were coupled to the solid phase.…”

“…The quantitation of in vitro IgE antibodies to BPO has been a useful tool for evaluating allergic reactions to penicillins (9)(10)(11). Although initially this method used penicillin conjugated to human serum albumin (HSA), other carriers have been employed.…”

Penizillinallergie als ein diagnostische Problem

“…Die Abklärung durch die Bestimmung des antibiotikumspezifischen IgE wird nicht einheitlich empfohlen, da der CAP-Test im Vergleich zu den Hauttestungen eine geringere Sensitivität be-sitzt und die Bestimmung mehr Zeit in Anspruch nimmt [27,28,29,49,58,59]. Außerdem ist eine Bestimmung der Minordeterminante im CAP-Test nicht möglich [18,58], aber wichtig, da gerade hier bei entsprechender Sensibilisierung schwere Allgemeinreaktionen beschrieben sind [19,30,34,40].…”

“…In unserer Untersuchung konnte die Sensitivität des CAP-Tests mit 17,9% berechnet werden und ist somit sehr gering. 60-95% angegeben [14,27,29,49,58]. In unserer Untersuchung konnte nachgewiesen werden, dass nicht alle Patienten mit positivem CAP-Test auch in den Hauttestungen nachweisbare Antikörper aufwiesen.…”