PPL and MDM skin test: New test kit is helpful in detecting immediate‐type allergy to beta‐lactams

Treudler, Regina; Simon, Jan C.

doi:10.1111/j.1610-0387.2007.06245.x

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Van Dellen and Gleich, 1970 25 Sullivan et al, 1981 26 Romano et al, 1995 27 Romano et al, 1997 28 31 Sogn et al, 1992 32 PPL+ benzylpenicillin + benzylpenicilloate + benzylpenilloate Adkinson, Jr., et al, 1971 33 Chandra et al, 1980 34 Mendelson et al, 1984 35 Gadde et al, 1993 36 Pichichero and Pichichero, 1998 37 Klaustermeyer and Gowda, 2005 38 Treudler et al, 2007 39 Frigas et al, 2008 40 Nolan et al, 2008 41 Raja et al, 2009 42 PPL + benzylpenicillin + benzylpenicilloate + benzylpenilloate + amoxicillin Macy et al, 1997 43 Macy et al, 2010 44 Lin et al, 2010 45 Kopac et al, 2012 46 Geng et al, 2017 47 Marwood et al, 2017 48 51 Matheu et al, 2007 52 Romano et al, 2007 53 Romano et al, 2009 54 Romano et al, 2010 55 Richter et al, 2011 56 Al-Ahmad et al, 2014 57 Bourke et al, 2015 58 Abbreviations: MDM, minor determinant mixture; PPL, penicilloyl-polylysine.…”

Section: Ppl+ Benzylpenicillin + Benzylpenicilloate + Ampicillin + Other Reagentsmentioning

confidence: 99%

“…70,71 The safety of penicillin skin testing was assessed in a review of 54 studies published over a period of 49 years. [13][14][15][16][17][18][19][20][21][22][24][25][26]30,[32][33][34][36][37][38][39][41][42][43][44][45][46][47][48][49][50][52][53][54][55][56][57][58][72][73][74][75][76][77][78][79][80][81][82][83][84]...…”

Section: Sensitivity and Safety Of Penicillin Skin Test Evaluations In History-positive Patientsmentioning

confidence: 99%

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Penicillin minor determinants

Adkinson

Mendelson

Ressler

et al. 2018

Annals of Allergy, Asthma & Immunology

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To review the history of the penicillin minor determinants and evaluate their relevance for current diagnosis. Data Sources: Skin testing to detect immunoglobulin E (IgE) sensitivity to penicillins in patients with a history of penicillin allergy has been the subject of more than 55 years of published research involving tens of thousands of patients. Study Selections: Selection of data was based on its relevance to the objective of this article. Results: It was established early on that testing with the major penicilloyl determinant using the polyvalent penicilloyl-polylysine (PPL) is negative in a substantial portion (10% to 64%, including recent increases) of those at risk for immediate hypersensitivity reactions. A variety of minor penicillin determinants are clinically significant in that their use in skin testing is essential to detect all those at risk. In particular, a minor determinant mixture of benzylpenicillin, benzylpenicilloate, and benzylpenilloate, used in conjunction with PPL, has been shown in numerous studies to achieve an average negative predictive value (NPV) of 97.9% in history-positive patients. Benzylpenicillin alone, as the sole minor determinant, leaves many skin test−positive patients undiscovered. Use of amoxicillin as an additional minor determinant reagent appears to identify another 2% to 8% of skin test−positive patients in some populations. Conclusion: IgE skin testing, using both the major and appropriate minor determinants of penicillin, can identify, with a high degree of reliability (NPV »97%), penicillin allergy history−positive patients who can receive betalactam antibiotics without concern for serious acute allergy, including anaphylaxis. The few false-negative skin tests reported globally are largely confined to minor, self-limited cutaneous reactions.

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Section: Ppl+ Benzylpenicillin + Benzylpenicilloate + Ampicillin + Other Reagentsmentioning

confidence: 99%

Section: Sensitivity and Safety Of Penicillin Skin Test Evaluations In History-positive Patientsmentioning

confidence: 99%

Penicillin minor determinants

Adkinson

Mendelson

Ressler

et al. 2018

Annals of Allergy, Asthma & Immunology

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“…This new kit contains PPL, yet the MDM now only comprises benzylpenicilloate, eliminating benzylpenicillin and benzyl penicilloic acid from the classical evaluation [5]. Although some concern remains that the elimination of this compounds will lead to a reduction of sensitivity in the skin test evaluation, multiple studies carried so far have reveal that these two formulations are equivalent [21][22][23].…”

Section: Immediate Hypersensitivitymentioning

confidence: 99%

Antibiotic Allergy: A Clinical Review

Santos¹,

Machado²

2017

J Allergy Ther

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Introduction: Antibiotics are commonly associated with hypersensitivity reactions. These can be expressed through clinical manifestations that range from mild symptoms to severe life-threating reactions. Nevertheless, these are often mistaken with adverse events. Incorrect labeling off a patient as allergic, leads to increase in costs and morbidity in the health care setting. Objectives: Review currently available information on evaluation, diagnosis and treatment of allergic antibiotic reactions. Methods: A search was conducted in the PubMed, filtering results to articles published in the last ten years, in English, in adults and with full texts available. Out of the eight hundred and twenty-six results, seventy-three were selected. Results: Diagnosis of allergic events requires a detailed anamnesis. Confirmation of the diagnosis is influenced by the clinical features and the type of reaction, immediate or nonimmediate. The first can be evaluated with skin tests and drug provocation tests. The latter are studied with delayed-reading skin tests and drug provocation tests. Management of these patients should follow avoidance and application of an alternative tolerated drug. However, if the drug in question is indispensable for the treatment of the patient, then desensitization can be tried. Discussion: Clinical history is a fundamental component in the management of these patients. Skin tests are less well validated to antibiotics other than β-lactam. In vitro tests have not been fully validated in large samples of subjects. Desensitization has been validated for patients with β-lactam immediate reactions, but further investigation is required for non-immediate reactions, as well as, for non β-lactam antimicrobials. Conclusion: Management of antimicrobial hypersensitivity follows specific considerations in function of the type of allergic reaction and antibiotic class. Further investigation regarding immunochemistry and validation of diagnostic tests for non β-lactam antibiotics is required.

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