Utility of minor determinants for skin testing in inpatient penicillin allergy evaluation

Geng, Bob; Eastman, Jacqueline J.; Mori, Karen Hiromi; Braskett, Melinda; Riedl, Marc A.

doi:10.1016/j.anai.2017.06.009

Cited by 16 publications

(9 citation statements)

References 31 publications

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“…Another concern for this study was the fact that we designed cHBIs to target only the well-known major determinant of the penicillin allergy while not taking minor allergy determinants into account. Although literature reports have shown skin prick test reactions to minor penicillin allergy determinants, our results established that a single cHBI can still be effective in mice (27). We believe this is due to the high degree of homology between the major penicillin determinant, penicilloyl, and minor determinants such as penicilloate and penilloate and the high cross-reactivity between b-lactam antibiotics (28,29).…”

Section: Discussionmentioning

confidence: 54%

Covalent Heterobivalent Inhibitor Design for Inhibition of IgE-Dependent Penicillin Allergy in a Murine Model

Deak

Kim

Koh

et al. 2019

The Journal of Immunology

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P.E.D. synthesized and characterized all compounds used in this study, performed most in vitro experiments, and analyzed these data, made all figures, and wrote the manuscript. B.B. and P.E.D. conceived of the idea for the study, designed the molecules, and designed all experiments. T.K. helped in experimental design and manuscript writing and editing. B. Kim performed affinity measurements for cHBI compounds and aided with in vitro studies. B. Koh and A.A.Q. performed all in vivo murine experiments and performed analysis. M.H.K. designed in vivo experiments, analyzed in vivo data, and helped to edit the manuscript.

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Section: Discussionmentioning

confidence: 54%

Covalent Heterobivalent Inhibitor Design for Inhibition of IgE-Dependent Penicillin Allergy in a Murine Model

Deak

Kim

Koh

et al. 2019

The Journal of Immunology

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“…Another large US study of inpatient penicillin-allergy skin testing (with 90% performed by a nurse) found a much higher rate (20%) of positive skin tests, but utilised minor determinant skin tests with different criteria for a positive skin test. 55 Another study utilised telemedicine to reduce the need for on-site allergy specialists, with skin testing performed by physician assistants. 56 Some studies have performed penicillin-allergy testing in the emergency department; however, higher than typical rates of positive skin tests (15.5%) might suggest that the 30 min training session for testers was inadequate.…”

Section: Inpatient-based Penicillin Skin Testing Programmesmentioning

confidence: 99%

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

Savic

Khan

Kopač

et al. 2019

British Journal of Anaesthesia

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Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.

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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%

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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Utility of minor determinants for skin testing in inpatient penicillin allergy evaluation

Cited by 16 publications

References 31 publications

Covalent Heterobivalent Inhibitor Design for Inhibition of IgE-Dependent Penicillin Allergy in a Murine Model

Covalent Heterobivalent Inhibitor Design for Inhibition of IgE-Dependent Penicillin Allergy in a Murine Model

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

Penicillin minor determinants

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