Penicillin skin testing in advance of need: Multiyear follow-up in 568 test result-negative subjects exposed to oral penicillins

Macy, Eric; Mangat, R.; Burchette, Raoul J.

doi:10.1067/mai.2003.1385

Cited by 102 publications

(47 citation statements)

References 12 publications

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“…Antunez et al 38 avaliaram 24 pacientes com reação anterior imediata à cefalosporina e RAST positivo para esse antibiótico. Esses autores observaram que dois pacientes também apresentavam testes cutâneos positivos à penicilina, enquanto os demais 22 foram negativos aos determinantes antigênicos da penicilina e toleraram a administração parenteral da penicilina. Os autores demonstraram que a cadeia lateral R1, e não a estrutura ß-lactâmica, comum a ambas as drogas, havia sido crucial para o reconhecimento imunológico.…”

Section: O Diagnóstico De Alergia Foi Confirmado E a Dessensibilização?unclassified

“…Portanto, os testes alérgicos realizados com essas drogas apresentam boa capacidade preditiva para reações imediatas. O risco teórico de re-sensibilização do paciente com história positiva, mas teste cutâneo negativo é baixo, da ordem de 3% 22 . Portanto, nesse caso, e tendo tolerado o tratamento com o antibiótico ß-lactâmico, não há necessidade novamente de testes (Figura 2).…”

Section: S181 Introduçãounclassified

“…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

“…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. 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.…”

Section: S181 Introduçãounclassified

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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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Section: O Diagnóstico De Alergia Foi Confirmado E a Dessensibilização?unclassified

Section: S181 Introduçãounclassified

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Allergy to beta-lactams in pediatrics: a practical approach

Grumach

2006

J Pediatr (Rio J)

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“…With regard to individuals who had a positive skin test right at the beginning of the study, some of the associated factors included having asthma, being female, and having atopic disease. Macy et al 48 assessed 568 patients exposed to oral penicillin, with a negative skin test. Of these patients, only 11.4% had some adverse reaction to penicillin in a four-year evaluation period, and none of the reactions was severe.…”

Section: Clinical Picture and Diagnosismentioning

confidence: 99%

Reações alérgicas a medicamentos

Nagão-Dias¹,

Barros-Nunes²,

Coêlho³

et al. 2004

J. Pediatr. (Rio J.)

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Objective: This review addresses the most recent published literature regarding drug allergy, in order to provide physicians with a background for a better understanding of this problem of great relevance for public health. Sources of data:The sources of data for obtaining the original and review articles published in the last 10 years were MEDLINE, Pubmed and Lilacs. The articles chosen for this review relate drug allergy to immunological mechanisms, epidemiology, clinical and laboratory evaluation, skin lesions, clinical management, and re-exposure to the drug.Summary of the findings: Allergic reactions represent one third of adverse drug reactions. They are considered rare but with high morbimortality. Gell & Coombs definition has been useful for classifying some types of drug allergic reactions; however, some still remain without classification because of poor knowledge of the mechanisms involved. The existence of T cell subpopulations with diverse characteristics reveals the complexity of the subject and, at the same time, elucidates several questions raised about it. It was recently postulated a new concept of chemically inert drug presentation to T cells, restricted to the major histocompatibility complex, but in a non-covalent and labile way. In clinical practice, without adequate laboratory tests, it is difficult to correlate clinical symptoms and immunological mechanisms. In vitro and in vivo skin tests have been employed in cases of suspected drug allergy reaction. However, there are very few commercially available reagents.Conclusions: Drug allergy constitutes an important problem in adverse drug reactions because of its potential of morbidity and mortality. It is necessary to emphasize the relevance of pharmacovigilance during treatment of patients, as well as the identification of possible immunological mechanisms involved in the events, through laboratory tests and detailed history and clinical evaluation.

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Penicillin Skin Testing: Potential Implications for Antimicrobial Stewardship

2013

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As the progression of multidrug-resistant organisms and lack of novel antibiotics move us closer toward a potential postantibiotic era, it is paramount to preserve the longevity of current therapeutic agents. Moreover, novel interventions for antimicrobial stewardship programs are integral to combating antimicrobial resistance worldwide. One unique method that may decrease the use of second-line antibiotics (e.g., fluoroquinolones, vancomycin) while facilitating access to a preferred β-lactam regimen in numerous health care settings is a penicillin skin test. Provided that up to 10% of patients have a reported penicillin allergy, of whom ~10% have true IgE-mediated hypersensitivity, significant potential exists to utilize a penicillin skin test to safely identify those who may receive penicillin or a β-lactam antibiotic. In this article, we provide information on the background, associated costs, currently available literature, pharmacists' role, antimicrobial stewardship implications, potential barriers, and misconceptions, as well as future directions associated with the penicillin skin test.

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Penicillin skin testing in advance of need: Multiyear follow-up in 568 test result-negative subjects exposed to oral penicillins

Cited by 102 publications

References 12 publications

Allergy to beta-lactams in pediatrics: a practical approach

Allergy to beta-lactams in pediatrics: a practical approach

Reações alérgicas a medicamentos

Penicillin Skin Testing: Potential Implications for Antimicrobial Stewardship

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