The very limited usefulness of skin testing with penicilloyl-polylysine and the minor determinant mixture in evaluating nonimmediate reactions to penicillins.

Abstract

BACKGROUND:

The contribution of skin testing with penicilloyl-polylysine (PPL) and the minor determinant mixture (MDM) to the diagnosis of hypersensitivity reactions to penicillins differs greatly according to the type of reaction: immediate (occurring within 1 h after the last drug administration) or nonimmediate (occurring more than 1 h after the last drug administration).

OBJECTIVE:

To assess the contribution of skin testing with PPL and MDM to the diagnosis of nonimmediate reactions to penicillins.

METHODS:

We evaluated 162 adults who had had 232 nonimmediate reactions to penicillins, mostly aminopenicillins, and presented positive skin and/or patch tests to one or more penicillin reagents: PPL, MDM, benzylpenicillin, ampicillin, and amoxicillin, as well as any responsible penicillins.

RESULTS:

A total of 157 subjects (96.9%) displayed patch-test and/or delayed-reading intradermal-test positivity to penicillin reagents, which indicates a cell-mediated hypersensitivity; six of them also presented immediate-reading skin-test positivities. All 157 patients with a cell-mediated hypersensitivity were positive to the responsible penicillins (parent drugs); 16 of them also displayed delayed-reading intradermal-test positivity to MDM. Five (3.1%) of the 162 patients displayed only immediate-reading skin-test positivity (four to PPL and one to amoxicillin). Overall, 158 subjects (97.5%) presented positive responses to the responsible penicillins, while only 9 (5.5%) and 17 (10.5%) were positive to PPL and MDM, respectively.

CONCLUSIONS:

The contribution of skin testing with PPL and MDM in diagnosing nonimmediate hypersensitivity reactions to penicillins, especially cell-mediated ones, is very limited. This finding could be useful at a time when PPL and MDM are not available in all countries.

• Authors: A Romano, F Gaeta, R L Valluzzi, C Caruso, G Rumi, P J Bousquet
• Journal: Allergy (Allergy) Vol. 65 Issue 9 Pg. 1104-7 (Sep 2010) ISSN: 1398-9995 [Electronic] Denmark
• PMID: 20121762 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Benzeneacetamides
• Penicillins
• Polylysine
• penicilloyl polylysine
• Penicillanic Acid

Topics

• Adolescent
• Adult
• Aged
• Benzeneacetamides (administration & dosage)
• Drug Hypersensitivity (diagnosis)
• Female
• Humans
• Hypersensitivity, Delayed (diagnosis)
• Hypersensitivity, Immediate (diagnosis)
• Male
• Middle Aged
• Patch Tests
• Penicillanic Acid (administration & dosage, analogs & derivatives)
• Penicillins (adverse effects, immunology)
• Polylysine (administration & dosage, analogs & derivatives)
• Skin Tests (methods)
• Young Adult