The Journal of Allergy and Clinical Immunology: In Practice
Original ArticleOral Challenge without Skin Testing Safely Excludes Clinically Significant Delayed-Onset Penicillin Hypersensitivity
Section snippets
Patients and skin tests
From June 2011 to April 2015 all subjects referred for allergic evaluation of BL hypersensitivity underwent ID ST with PPL (0.04 mg/mL, 1:10 and 1:1), minor determinants mixture (0.5 mg/mL, 1:10 and 1:1) and amoxicillin (20 mg/mL, 1:10 and 1:1) (all produced by Diater, Madrid, Spain), and penicillin G 10,000 U/mL (Teva, Petach-Tikva, Israel). If the culprit BL was different, patients were also tested ID with the relevant drug: amoxicillin-clavulanic acid 20 mg/mL (Augmentin by GSK, Brentford,
Patients
Seven hundred and ten patients with alleged beta-lactam hypersensitivity were screened (Figure 1). Fifty-two patients (7.3%) had histories of an immediate reaction to BL. Therefore, they were excluded from the oral challenge portion of the study. Sixteen patients with cephalosporin hypersensitivity were prospectively identified. Because this group was too small to analyze, and because they are potentially different than the penicillin patients, they were excluded from the rest of the results.
Discussion
Beta-lactams are the most prescribed group of antibiotics, with somewhere between 3.6 g and 23 g per 1000 people per day prescribed in Europe.5 Delayed skin rashes, mostly described as maculopapular or urticarial, are frequently reported in patients administered BL, especially in children. Such rashes are assumed to be a drug-related or viral infection-induced.6 Most physicians, for fear of a future anaphylactic reaction, state to the patients that they are allergic to penicillin and ought to
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No funding was received for this work.
Conflicts of interest: The authors declare that they have no relevant conflicts of interest.
This study is dedicated to Prof. Arnon Goldberg our beloved mentor, friend, and colleague who passed away in the course of this research.