Etudes sur l’allergie à la pénicilline. IV. Les tests cutanés dans l’allergie à la pénicilline

Studies on Penicillin Hypersensitivity

“…Skin testing with conjugates and polyvalent haptens, as well as inhibition of the skin reactions with haptens, have shown that penicilloyl and pcnicillenate groups are significant antigenic deter minants in human beings allergic to penicillin (24,33). Preliminary experiments show that the antibodies responsible for hemagglutina tion reactions in the sera of such individuals have similar specifici ties as rabbit "anti-penicillin" antibodies.…”

Newer Developments in Penicillin Immunochemistry

“…These results are in striking contrast with the low incidence of wheal-and erythema reactions in allergic patients when peni cillin itself is used as a test reagent (14). Under such circumstances, the penicillin and penicillenic acid injected intradermally will have to form readily suitable protein conjugates in situ in order to elicit the reaction.…”

“…There is definite indication that an identical mechanism is responsible for most of the immediate-type allergies to penicillin in man (13,14,15). In about 80% of the cases of untoward reactions following the administration of penicillin (14), the symptoms are of such nature (anaphylactic shock, urticaria, angioneurotic edema) that the presence of circulating antibodies and of a hypersensitivity of the immediate-type has to be suspected.…”

“…In about 80% of the cases of untoward reactions following the administration of penicillin (14), the symptoms are of such nature (anaphylactic shock, urticaria, angioneurotic edema) that the presence of circulating antibodies and of a hypersensitivity of the immediate-type has to be suspected. In fact, on a total of 263 patients with a history of penicillin allergy investigated so far in the US and in Switzerland (13,14,15,16), 81% exhibit an immediate wheal-and-erythema to a scratch-test or intradcrmal injection of penicilloyl-polylysine, a plurifunctional hapten where the carrier molecule is a polylysine averaging 20 lysines residues per molecule and which bears 12-15 penicilloyl groups. Such a test reagent was considered ideal for routine skin testing, as it is devoid of the high sensitizing potential of protein conjugates.…”

“…Under such circumstances, the penicillin and penicillenic acid injected intradermally will have to form readily suitable protein conjugates in situ in order to elicit the reaction. It is quite understandable that this can be at best an unefFicient process, involving numerous adverse factors (14,16).…”