IgE antibodies against penicillin as determined by Phadebas RAST

Abstract

Summary Serum samples from eighty‐one patients with suspected penicillin allergy were investigated with Phadebas RAST using the penicillin derivatives Benzylpenicilloyl‐human serum albumin (PBO‐HSA) and Phenoxymethylpenicilloyl‐human serum albumin (PMPO‐HSA) and the results were compared with skin test results and clinical data. Of the sixty‐one patients who had anaphylactic shock and/or urticaria as a possible consequence of penicillin administration, reagins against PBO‐HSA and PMPO‐HSA could be detected in thirty‐four cases (56%). Five per cent of these patients, with positive RAST results, showed negative skin tests; in the other 95% both RAST and skin tests were positive. All, except eight, of the RAST‐negative patients had had their adverse reactions at least 2 years prior to the blood sampling and in some of these cases skin tests were also negative. RAST and provocation test results agreed in 80% of the cases where exposition was performed. It is concluded that the RAST technique is a valuable diagnostic tool for the detection of immediate type hypersensitivity to penicillin.

Diagnostic evaluation of a large group of patients with immediate allergy to penicillins: the role of skin testing

“…However, at present, even including AX and AMP or other determinants in the skin test, the population that can be diagnosed is still lower than before. We can therefore conclude that skin test sensitivity is now lower than previously estimated (34, 36, 39). It is also relevant to mention that, although prick tests detected positivity in 30% of the cases, in intradermal tests the most sensitive concentration was the maximum used.…”

“…Moreover, in the present study, skin tests were positive in only 70.3% of the cases. Although no studies have been carried out in Spain in the same population by the same group, data reported in 1979 indicated that the most relevant determinant was BPO, with AMP and BP being the drugs most commonly prescribed (36). Although different reports have indicated that other semisynthetic penicillins such as cloxacillin, metampicillin, or ampicillin could contribute to positive skin test responses (13, 29), detailed analyses in both Spanish and Italian populations have shown that AMP does not induce specific reactions (11).…”

Allergy to penicillin unsuccessfully treated with a haptenic inhibitor (benzyl‐penicilloyl‐N2‐formil‐lysine; BPO‐Flys)

“…RAST analysis has proved in previous studies to be a good technique for the detection of IgE-specific antibodies against penicilloyl group determinants (Wide & Juhlin, 1971;Juhlin & Wide, 1972;Kraft & Wide, 1976;Basomba et al, 1978). In the present case the RAST result was strongly positive before starting the treatment with penicillin and the inhibitor, while the PK test was negative.…”

“…The coupling procedure of PMPO-HSA and BPO-HSA to activated paper discs was essentially the same as that described by Ceska, Eriksson & Varga (1972) and Ceska & Lundkvist (1972). The background level (ct/min) ofeach serum sample tested was established by running discs to which HSA (human serum albumin) was coupled, in duplicate and in parallel with the penicilloyl-HSA RAST, and a RAST response greater than twice the HSA mean count level was considered positive (Basomba et al, 1978).…”

Challenge of Penicillin‐Allergic Volunteers with Penicillin‐Contaminated Meat

“…Erom penicillin Table 2 Case history and symptoms of volunteers following challenge with jjenicillin-contaminated pork several other antigens may be derived, collectively referred to as minor determinants. Clinical and in vitro studies have shown that anaphylactic type reactions are largely or entirely mediated by IgE antibodies (1,3,12,13,15,16,33). Whereas penicillin allergy after medical treatment is a well-observed phenomenon, the influence of hidden amounts of penicillin in the environment on the course of allergic reactions is not entirely clear (2).…”