Penicillin allergy: clinical quandaries

Anaphylaxis to excipient mannitol: evidence for an immunoglobulin E‐mediated mechanism

“…Hapten-protein conjugates have been used earlier by other investigators to demonstrate hapten-specific IgE by SPT and ELISA, and to delineate a haptenic epitope responsible for hypersensitivity [37][38][39][40][41][42][43][44][45][46][47][48]. Some examples of low-molecular-weight chemicals (including drugs and vitamins) that have been shown to act as haptens are chlorogenic acid [37,38], penicillin [39][40][41], sulpha drugs [42][43][44], chlorhexidine [45], thiamine [46], folic acid [47], and pyridoxal [48]. Hypersensitivity reactions to erythritol, a four-carbon polyol used as a non-caloric sweetener in foods and beverages, have been described recently [49,50].…”

Varying penicillin allergy testing practices in the United States: A time for consensus

“…There is also an ongoing debate as to the current utility of various locally produced minor determinant mixtures (MDMs), which have never been commercially available in the United States. 3 The most recent allergy practice parameter strongly recommends using PPL when testing for penicillin allergy, but leaves the use of MDMs, aminopenicillins, or penicillin G up to individual providers. 4 There is no current official recommendation to oral challenge all individuals with negative skin test results, though this criterion standard test has been shown to be safe and effective in both the United States and abroad.…”