IgE response to penicillin

Geyer, E.; Derhaschnig, J.; Aberer, Werner

doi:10.1111/j.1398-9995.1997.tb01049.x

Cited by 1 publication

(2 citation statements)

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“…In another study Macy et al [ 15 ] challenged four patients with positive s-IgE (skin test negative), all with negative outcome. Aberer et al [ 16 – 18 ] stated that detection of IgE antibodies to penicillin does prove sensitization, but not the existence of a clinical allergy. Torres et al [ 19 ] who studied 40 patients with positive s-IgE and negative skin test, found however that 24 patients had a positive IR (immediate reaction) to penicillin during challenge.…”

Section: Discussionmentioning

confidence: 99%

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Positive serum specific IgE has a short half‐life in patients with penicillin allergy and reversal does not always indicate tolerance

Hjortlund

Mørtz

Stage

et al. 2014

Clinical & Translational All

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BackgroundThe positive and negative predictive values of specific IgE to penicillins are not well established for penicillin hypersensitivity. One reason may be that serum IgE levels to penicillin diminish over time. The objective in this study was to investigate variations in serum half-life (T½) for specific IgE to penicillins (s-IgE) and to evaluate the outcome of penicillin challenges in patients with previous but not present specific IgE to penicillins.MethodsTwo subgroups were investigated. All included patients had a history of penicillin allergy with reported symptoms such as urticaria/angioedema or unclassified cutaneous rash. T½ of specific IgE to penicillins was calculated based on sera from 29 patients with repeated measurements of s-IgE. Twenty-two patients with a previous positive s-IgE was followed and challenged with penicillin when IgE had become negative.ResultsThe T½ for s-IgE varied between the 26 patients with decreasing s-IgE from 1.6 months to 76.4 months and 52% had a T½ of less than a year. The three patients with stable and increasing IgE-values showed T½ approaching infinity A total of 29 challenges with β-lactams were performed. Four different patterns were seen when evaluating the clinical reaction to challenge (positive/negative) and post-challenge boost of s-IgE (yes/no). Eight (36.4%) had negative challenge and negative post-challenge s-IgE, eight (36.4%) negative challenge, but positive post-challenge s-IgE levels. 3 (13.6%) had positive challenge and positive post-challenge s-IgE whereas 3 (13.6%) were challenge positive, but had negative post-challenge s-IgE.ConclusionSpecific IgE to penicillins declines over time stressing the importance of a close time relation between diagnostic work-up and clinical reaction. Reversal of previously positive s-IgE may still be associated with positive penicillin challenges and/or re-boostering of s-IgE to positivity.

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Section: Discussionmentioning

confidence: 99%

“…Several studies have evaluated [7, 15–20] the positive and negative predictive value of s‐IgE in patients with a positive history of penicillin allergy but negative skin tests by performing oral/i.v. challenge test.…”

Section: Discussionmentioning

confidence: 99%