Female sex as a risk factor for penicillin allergy

Park, Miguel A.; Matešić, Damir; Markus, Patricia J.; Li, James T.C.

doi:10.1016/s1081-1206(10)60621-7

Cited by 75 publications

(47 citation statements)

References 21 publications

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“…The age of the patient did not significantly affect these greater odds for a positive skin test in women. Park et al [30] showed a significantly higher odds ratio of 3.6 for female gender as a risk factor for a positive PST than that found in our study (1.47). In contrast, Sullivan et al [31] showed no effect of gender on PST results.…”

Section: Discussioncontrasting

confidence: 82%

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

Lin¹,

Saxon²,

Riedl³

2010

Int Arch Allergy Immunol

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Background: Allergy to penicillins remains an important issue. Penicillin skin testing (PST) with major and minor determinants has been shown to be a highly valuable tool for identifying IgE-mediated penicillin allergy. The value of additional testing with side-chain-specific moieties from semisynthetic penicillins such as amoxicillin is not well-established in spite of the widespread use of these medications. Methods: A retrospective review of all consecutive inpatient PST results from 1995 to 2007 comprising 1,068 patients was performed in our institution on individuals with a self-reported history of beta-lactam allergy to assess the importance of including the amoxicillin determinant in a previously validated PST panel. Descriptive statistics were performed. The PST panel included penicilloyl-polylysine, penicillin G, penicilloate, penilloate and amoxicillin. Results: Of 1,068 patients, 243 (23%) had a positive skin test reaction on the PST panel. Testing with amoxicillin was positive in 30.9% of patients, the majority of whom (81%) were also positive to 1 or more standard penicillin reagents. Fourteen of the 243 positive patients (5.8%) had a positive skin test reaction only to amoxicillin. Additionally, the use of penicilloate and penilloate minor determinants in combination with penicillin G identified a greater percentage of penicillin-allergic individuals compared to using only penicillin G (22.6 vs. 6.6%), demonstrating their importance in the PST panel. Conclusions: These data indicate that the inclusion of the amoxicillin determinant appears to identify a small but important group of allergic individuals who may otherwise test negative on a PST panel.

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Section: Discussioncontrasting

confidence: 82%

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

Lin¹,

Saxon²,

Riedl³

2010

Int Arch Allergy Immunol

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“…Thus, the PenST is a very useful clinical tool in older individuals who are more likely to be hospitalized and, when in the hospital, much more likely to require antibiotics. 18 We did not see higher rates of positive findings on PenSTs in women, as reported recently by Park et al 6 We did see overall similar low rates of positive findings on PenSTs in adults. Penicillin skin testing as we describe is safe.…”

Section: Discussionsupporting

confidence: 72%

“…1,2 There have been higher rates for positive penicillin skin test (PenST) results reported in recent studies from Europe and the Middle East compared to most recent studies from the US. [3][4][5][6][7] The literature on IgE-mediated penicillin allergy has become increasingly difficult to analyze 8 for the following reasons: 1) reports of PenST results are marked by differences in populations studied, testing criteria, reagents, and testing methods; 2) some studies have very small sample sizes and include individuals with histories of reactions to nonpenicillin β-lactams; 9 3) there are significant disagreements on the concentration of native amoxicillin that should be used for testing;…”

Section: Introductionmentioning

confidence: 99%

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

Macy¹,

Schatz²,

Lin³

et al. 2009

TPJ

106

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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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“…13 This appears to be due to our using 5 mm or greater wheal, with flare greater than wheal, as the definition of a positive penicillin skin test result as opposed to the 3 mm or greater threshold used by the Park group at the Mayo Clinic.…”

Section: Discussionmentioning

confidence: 99%

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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Female sex as a risk factor for penicillin allergy

Cited by 75 publications

References 21 publications

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

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

Adverse Reactions Associated with Therapeutic Antibiotic Use after Penicillin Skin Testing

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