Natural evolution of skin test sensitivity in patients allergic to β-lactam antibiotics,☆☆,

https://doi.org/10.1016/S0091-6749(99)70439-2Get rights and content

Abstract

Background: Subjects with immediate reactions to penicillins and positive skin test responses may lose sensitivity if penicillin is avoided. The longer the interval between the reaction and the skin test, the greater the likelihood of having a negative result. Objective: We sought to study prospectively the evolution of skin test sensitivity in a group of subjects allergic to penicillin with positive skin test responses to different penicillin determinants. Methods: Skin tests were performed with major and minor determinants of benzylpenicillin (BPO/MDM), amoxicillin (AX), and ampicillin at the initial evaluation and repeated 1, 3, and 5 years later if the responses were still positive. Subjects were divided into 2 groups. Group A consisted of patients with a positive skin test response to benzylpenicilloyl or minor determinant mixture, and group B consisted of those with a selective response to amoxicillin and good tolerance to benzylpenicillin. Results: In group A (n = 31) after 1 year, 25 patients continued to have positive responses and 6 began to have negative responses; after 3 years, 18 continued to have positive responses, 5 began to have negative responses, and 2 were lost to follow-up; and after 5 years, 12 continued to have positive responses, 5 began to have negative responses, and 1 was lost to follow-up. In group B (n = 24) 12 had positive responses, and 12 had negative responses after 1 year; 6 had positive responses, 5 had negative responses, and 1 was lost to follow-up after 3 years; and no patients had positive responses, 5 had negative responses, and 1 was lost to follow-up after 5 years. Survival analysis showed significant differences between groups (log-rank test = 12.8; P < .0003). Conclusion: Patients with a selective response to amoxicillin tended to lose sensitivity faster than those who responded to several penicillin determinants, supporting the existence of at least 2 distinct types of IgE response in patients allergic to β-lactam. (J Allergy Clin Immunol 1999;103:918-24.)

Section snippets

Subjects

All patients who came to our clinic as a consequence of having had an immediate allergic reaction to a penicillin derivative by the oral or parenteral routes were eligible for inclusion in the study. Those with a positive skin test response to at least 1 of the penicillin determinants mentioned below were followed. To avoid any inadvertent contact during the follow-up period, we excluded those patients potentially exposed to penicillins, such as health care workers, pharmacists, veterinarians,

RESULTS

Fifty-five patients in whom an immediate allergic reaction to a penicillin derivative developed and who had positive skin test responses to at least 1 penicillin determinant were included in the study. Thirty-one had positive skin test responses to BPO and/or MDM, and these patients formed group A. The clinical characteristics of these patients and the drug eliciting the reaction are presented in Table I.

. Age, sex, diagnosis and drug involved in the reaction of patients from group A

PatientAge (y)

DISCUSSION

In this study we followed prospectively the evolution of skin test sensitivity in 2 groups of subjects with an allergic reaction to a β-lactam derivative and in whom a type I reaction was demonstrated by the presence of specific skin sensitizing IgE antibodies to 1 or more penicillin determinants. The same protocol for evaluation and immunologic tests was used throughout the study. Although a number of studies indicate that subjects with penicillin-induced allergic reactions gradually lose

Acknowledgements

We thank Ian Johnstone for help with the English language version of the text.

References (31)

  • ME Weiss et al.

    Immediate hypersensitivity reactions to penicillin and related antibiotics

    Clin Allergy

    (1988)
  • D Kraft et al.

    Specific and total serum IgE measurements in the diagnosis of penicillin allergy. A long term follow-up study

    Clin Allergy

    (1977)
  • M Blanca et al.

    Allergy to penicillin with good tolerance to other penicillins. Study of the incidence in patients allergic to betalactams

    Clin Exp Allergy

    (1990)
  • M Audicana et al.

    Allergic reactions to betalactams: studies in a group of patients allergic to penicillin and evaluation of cross-reactivity with cephalosporin

    Allergy

    (1994)
  • JM Igea et al.

    Allergy to cefazolin: study of in vivo cross reactivity with other betalactams

    Ann Allergy

    (1992)
  • Cited by (307)

    • Predicting Penicillin Allergy: A United States Multicenter Retrospective Study

      2024, Journal of Allergy and Clinical Immunology: In Practice
    • Penicillin Allergy Impact and Management

      2023, Infectious Disease Clinics of North America
    • Penicillin Allergy: Mechanisms, Diagnosis, and Management

      2023, Primary Care - Clinics in Office Practice
    • Assessing the prevalence and characteristics of self-reported penicillin allergy in Saudi Arabian population: A nationwide cross-sectional study

      2023, Saudi Pharmaceutical Journal
      Citation Excerpt :

      It has been proven that a considerable number of patients could potentially tolerate the use of penicillin safely after such time. About 80% of patients lose their penicillin sensitivity and may tolerate penicillin after ten years (Blanca et al., 1999). Efforts have been made to assess penicillin allergy status by taking a more detailed history from patients to differentiate tolerability issues from allergic reactions.

    View all citing articles on Scopus

    Supported in part by CICYT Grant SAF-240/96, BIOTECH ERB BIO4-CT96-0246 EEC Grant, the Fundación Carlos Haya, and Fundatione OASI María Santísima, Troina, Italy.

    ☆☆

    Reprint requests: Miguel Blanca, MD, PhD, Allergy Laboratory, Carlos Haya Hospital, Avd Carlos Haya s/n, 29010-Malaga, Spain

    0091-6749/99 $8.00 + 0  1/1/96023

    View full text