Penicillin resensitization among hospitalized patients

Parker, Peter J.; Parrinello, J.T.; Condemi, John J.; Rosenfeld, Stephen I.

doi:10.1016/0091-6749(91)90331-h

Cited by 84 publications

(50 citation statements)

References 8 publications

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“…We have no explanation for this, but resensitization cannot account for all cases as some patients tell that this is a recurring pattern whenever they are exposed to penicillin. However, resensitization after allergological tests is a concern and has been observed in patients retested about 1 month after negative allergological investigation, including DCT followed by full therapeutic courses [6,7,8] with frequencies ranging from 0.9 [6] to 27.9% [9], the latter primarily in patients with immediate reactions. It is thus advised to retest patients with immediate reactions [10].…”

Section: Discussionmentioning

confidence: 99%

Full-Course Drug Challenge Test in the Diagnosis of Delayed Allergic Reactions to Penicillin

Borch

Bindslev‐Jensen²

2011

Int Arch Allergy Immunol

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Background: Drug challenge test (DCT) has long been the most sensitive test in the allergological work-up when investigating for penicillin allergy. Objective: To improve sensitivity of the diagnostic work-up in diagnosing penicillin allergics with histories of allergic reactions on day 2 or later in the course of penicillin treatment. Methods: A full-course DCT was added to the current protocol if specific IgE, skin tests and DCT were all negative in patients who had a nonimmediate reaction to penicillin treatment. Sixteen patients with a history of an immediate reaction to penicillin treatment underwent testing with negative outcomes. Results: Fifty percent of patients undergoing full-course DCT experienced a cutaneous adverse drug reaction. None of the controls reacted (p = 0.001). The mean time of reaction was 6 days. Penicillin V accounted for most reactions. Urticaria was the most frequent clinical reaction observed. Conclusions: Full-course DCT offers an improvement of sensitivity and predictive values of the diagnostic work-up of allergic reactions to penicillin occurring on day 2 of penicillin treatment or later.

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Section: Discussionmentioning

confidence: 99%

Full-Course Drug Challenge Test in the Diagnosis of Delayed Allergic Reactions to Penicillin

Borch

Bindslev‐Jensen²

2011

Int Arch Allergy Immunol

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“…One early study reported re-sensitization after highdose parenteral penicillin with a conversion rate of 16% (3/18) [159]. Larger, more recent studies have established that patients with a previous history of penicillin allergy have a low risk of resensitization following assessment by skin testing and an oral course of penicillin [160,161].…”

Section: Resensitization Following Investigationmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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“…Portanto, nesse caso, e tendo tolerado o tratamento com o antibiótico ß-lactâmico, não há necessidade novamente de testes (Figura 2). Pacientes com histó-ria prévia de alergia à penicilina, com testes cutâneos negativos para penicilina, têm pouca probabilidade de novas reações ou re-sensibilização durante tratamentos subseqüentes com a penicilina [22][23][24][25] . Macy et al 22 revisaram prontuários de 568 indivíduos que receberam pelo menos um tratamento com penicilina oral após teste negativo.…”

Section: S181 Introduçãounclassified

“…Esses pacientes receberam entre 1 e 22 tratamentos (em média 4) e relataram reações em 27 (4,8%) dos pacientes testados (n = 568), tendo a maioria desenvolvido erupções cutâneas e nenhuma reação mais séria. Esses dados confirmaram achados prévios em crianças [24][25][26][27] .…”

Section: S181 Introduçãounclassified

Allergy to beta-lactams in pediatrics: a practical approach

Grumach

2006

J Pediatr (Rio J)

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Objective: To present a practical approach to the diagnosis and management of allergy to beta-lactam antibiotics.Sources: Allergy journals indexed in MEDLINE and LILACS, as well as seminal studies and texts.Summary of the findings: Allergy to penicillin is commonly reported. In many cases, this results in the decision not to use this drug. About 10% of drug allergy reports are confirmed. The clinical manifestations due to allergic reaction to penicillin vary widely, with emphasis on skin disorders. Gell & Coombs four hypersensitivity mechanisms are involved in allergic reactions. Penicillin is degraded to a major (95%) and minor determinants (5%). Immediate IgE-mediated reactions causing anaphylaxis are associated with minor determinants in 95% of the cases. Hypersensitivity to these products can be assessed using cutaneous tests performed with major and minor determinants, thus avoiding anaphylactic shock in allergic individuals. The present article underscores the basic body of knowledge on allergy to penicillin, providing support for a more accurate diagnosis of this event and for the choice of management in cases of suspected beta-lactam allergy. Conclusions:The incorrect diagnosis of penicillin allergy frequently leads to the exclusion of this drug as a therapeutic option. A better recognition of these situations will enable the use of penicillin and reduce the risks associated with hypersensitivity.J Pediatr (Rio J). 2006;82(5 Suppl):S181-8: Beta-lactam, penicillin, cephalosporin, allergy, hypersensitivity reaction. ResumoObjetivo: Apresentar uma abordagem prática ao diagnóstico e conduta na alergia a antibióticos beta-lactâmicos.Fontes dos dados: Periódicos da área de alergia indexados nas bases MEDLINE e LILACS, além de estudos e textos clássicos que tratam do tema. Síntese dos dados:A alergia à penicilina é relatada com freqüên-cia, em muitos casos resultando na exclusão desse medicamento do arsenal terapêutico. Cerca de 10% dos relatos de alergia a drogas são confirmados. As manifestações clínicas decorrentes da reação alérgica à penicilina são bastante amplas, destacando-se os quadros cutâneos. Os quatro mecanismos de hipersensibilidade de Gell & Coombs estão envolvidos nas reações alérgicas. A penicilina é degradada em determinante maior (95% dos produtos) e em determinantes menores (5% dos produtos). As reações imediatas, mediadas por IgE, e que determinam quadros de anafilaxia, estão relacionadas aos determinantes menores em 95% dos casos. A hipersensibilidade a esses produtos pode ser avaliada através de testes cutâneos realizados com os determinantes maior e menores, permitindo, assim, evitar o choque anafilático em indivíduos alérgicos. O texto ressalta conhecimentos básicos sobre a alergia à penicilina, propiciando um diagnóstico mais adequado desse evento e a conduta em casos de suspeita de alergia a beta-lactâmicos.Conclusões: O diagnóstico de alergia à penicilina tem sido feito de forma inadequada, resultando em sua exclusão do arsenal terapêutico. O melhor reconhecimento dessas cond...

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Penicillin resensitization among hospitalized patients

Cited by 84 publications

References 8 publications

Full-Course Drug Challenge Test in the Diagnosis of Delayed Allergic Reactions to Penicillin

Full-Course Drug Challenge Test in the Diagnosis of Delayed Allergic Reactions to Penicillin

Management of allergy to penicillins and other beta‐lactams

Allergy to beta-lactams in pediatrics: a practical approach

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