Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Allergy and Asthma Reports
Published in: Current Allergy and Asthma Reports 1/2013

01-02-2013 | ANAPHYLAXIS AND DRUG ALLERGY (P LIEBERMAN AND S SPECTOR, SECTION EDITORS)

Skin Testing For Beta-Lactam Antibiotics: Impact of the Availability of a Major Determinant

Authors: Fatima S. Khan, Michael E. Weiss

Published in: Current Allergy and Asthma Reports | Issue 1/2013

Login to get access

Abstract

Beta-lactam antibiotics are very effective agents for a variety of infections. In patients with beta-lactam allergy, these drugs are withheld due to fear of subsequent allergic reactions. Therefore, increasing their exposure to broad spectrum antibiotics, which are more costly, have greater side effects, and increase the risk of developing resistant organisms. Up to 90 % of patients with a proposed beta-lactam sensitivity can tolerate beta lactam agents after appropriate evaluation. Skin testing to beta-lactam agents is the gold standard in evaluating patients with type I, immediate hypersensitivity reactions. The robust negative predictive value of this test has yet to be surpassed by any other testing modality currently available.
Literature
1.
Gowda V. Penicillin skin testing: a 20-year study at west LosAngeles VA medical center. Mil Med. 2005;170(8):701–4.PubMed
2.
3.
• Solensky R, Khan DA. Drug allergy: an updated practice parameter. Ann Allergy, Asthma, Immunol. 2010;105:259–73. Joint Task Force on practice parameters of the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI) updated guidelines on evaluation of patients with drug allergy. CrossRef
4.
Li JTC, Markus PJ, Osmon DR, et al. Reduction of vancomycin use in orthopedic patients with a history of antibiotic allergy. Mayo Clin Proc. 2000;75:902–6.PubMedCrossRef
5.
Kraft D, Wide L. Clinical patterns and results of radioallergosorbent test (RAST) and skin tests in penicillin allergy. Br J Dermatol. 1976;94:593–601.PubMedCrossRef
6.
Kraft D, Roth A, Mischer P, Pichler H, Ebner H. Specific and total serum IgE measurements in the diagnosis of penicillin allergy: a long term follow-up study. Clin Allergy. 1977;7:21–8.PubMedCrossRef
7.
Spath P, Huber H, Ludvan M, Roth A, Schwarz S, Zeiger J. Determinations of penicilloyl specific IgE antibodies for the evaluation of hypersensitivity against penicillin. Allergy. 1979;34(6):405–11.PubMedCrossRef
8.
Jarisch R, Roth A, Boltz A, Sandor I. Diagnosis of penicillin allergy by means of Phadebas RAST penicilloyl G and V and skin tests. Clin Allergy. 1981;11:155–60.PubMedCrossRef
9.
Qiao HL, Liu JH, Yan J, Dong ZM. Relationships between skin test, specific IgE and levels of cytokines in patients with a history of penicillin allergy after receiving repeated penicillin courses. Arch Inter Med. 2002;162:822–6.CrossRef
10.
Adkinson Jr NF. Tests for immunological drug reactions. In: Rose NF, Friedman H, editors. Manual of clinical immunology. Washington: American Society for Microbiology; 1986. p. 692–7.
11.
Sullivan TJ. Penicillin allergy. In: Lichtenstein LM, Fauci A, editors. Current therapy in allergy. St. Louis: CV Mosby; 1985. p. 57–61.
12.
Gadde J, Spence M, Wheeler B, et al. Clinical experience with penicillin skin testing in a large inner city STD clinic. JAMA. 1993;270:2456–63.PubMedCrossRef
13.
Weiss ME, Adkinson Jr NF. Immediate hypersensitivity reactions to penicillin and related antibiotics. Clin Allergy. 1988;18:515–40.PubMedCrossRef
14.
Pichichero M, Pichichero D. Diagnosis of penicillin, amoxicillin and cephalosporin allergy: reliability of examination assessed by skin testing and oral challenge. J Pediatr. 1998;132:137–43.PubMedCrossRef
15.
Sullivan TJ, Wedner HJ, Shatz GS, et al. Skin testing to detect penicillin allergy. J Allergy Clin Immunol. 1981;68:171–80.PubMedCrossRef
16.
Chandra RK, Joglekar SA, Tomas E. Penicillin allergy: anti-penicillin IgE antibodies and immediate hypersensitivity skin reactions employing major and minor determinants of penicillin. Arch Dis Child. 1980;55:857–60.PubMedCrossRef
17.
Sogn DD, Casale TB, Condemi JJ, et al. Results of the NIAID collaborative clinical trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults. Arch Intern Med. 1992;152:1025–32.PubMedCrossRef
18.
Mendelson LML, Ressler C, Rosen JP, et al. Routine elective penicillin allergy skin testing in children and adolescents: study of sensitization. J Allergy Clin Immunol. 1984;73:76–81.PubMedCrossRef
19.
Solensky R, Earl HS, Gruchalla RS. Lack of penicillin resensitization in patients with a history of penicillin allergy after receiving repeated penicillin courses. Arch Intern Med. 2002;162:822–6.PubMedCrossRef
20.
Parker P, Parrinello JT, Condemi J, et al. Penicillin resensitization among hospitalized patients. J Allergy Clin Immunol. 1991;88:213–7.PubMedCrossRef
21.
Warrington RJ, Simons FER, Ho HW, et al. Diagnosis of penicillin allergy by skin testing: the Manitoba experience. Can Med Assoc J. 1978;11:787–91.
22.
Blanca M, Vega JM, Garcia J, et al. Allergy to penicillin with good tolerance to other penicillins: study of the incidence in subjects allergic to beta-lactams. Clin Exp Allergy. 1990;20:475–81.PubMedCrossRef
23.
Blanca M, Perez E, Garcia J, et al. Anaphylaxis to amoxycillin but good tolerance for benzylpenicillin. Allergy. 1988;43:508–10.PubMedCrossRef
24.
Silviu-Dan F, McPhillips S, Warrington R. The frequency of skin test reactions to side-chain penicillin determinants. J Allergy Clin Immunol. 1993;91:694–701.PubMedCrossRef
25.
Macy E, Richter P, Falkoff R, et al. Clinical aspects of allergic disease: skin testing with penicilloate and penilloate prepared by an improved method. Amoxicillin oral challenge in patients with negative skin test responses to penicillin reagents. J Allergy Clin Immunol. 1997;100:586–91.PubMedCrossRef
26.
27.
Martin J, Igea J, Fraj J, et al. Allergy to amoxicillin in patients who tolerated benzylpenicillin, aztreonam, and ceftazidime. Clin Infect Dis. 1992;14:592–3.PubMedCrossRef
28.
Romano A, Quaratino D, DiFonso M, et al. A diagnostic protocol for evaluating nonimmediate reactions to aminopenicillins. J Allergy Clin Immunol. 1999;103:1186–90.PubMedCrossRef
29.
Terrados S, Blanca M, Garcia J, et al. Nonimmediate reactions to betalactams: prevalence and role of the different penicillins. Allergy. 1995;50:563–7.PubMedCrossRef
30.
Sullivan TJ. Drug allergy. In: Middleton E, Reed C, Ellis E, et al., editors. Allergy: principles and practice. 4th ed. CV Mosby: St. Louis; 1993. p. 1523–34.
31.
Sullivan TJ, Yecies LD, Shatz GS, et al. Desensitization of patients allergic to penicillin using orally administered beta-lactam antibiotics. J Allergy Clin Immunol. 1982;69:275–82.PubMedCrossRef
32.
Adkinson Jr NF. Penicillin allergy. In: Lichtenstein LM, Fauci A, editors. Current therapy in allergy, immunology and rheumatology. Ontario: BS Decker; 1983. p. 57–62.
33.
Naclerio R, Mizrahi EA, Adkinson Jr NF. Immunologic observations during desensitization and maintenance of clinical tolerance to penicillin. J Allergy Clin Immunol. 1983;71:294–301.PubMedCrossRef
34.
Morales AR, Shah N, Castells M. Antigen-IgE desensitization in signal transducer & activator of transcription 6-deficient mast cells by suboptimal doses of antigen. Ann Allergy Asthma Immunol. 2005;575-580.
35.
Grieco MH. Cross-allergenicity of the penicillins and the cephalosporins. Arch Intern Med. 1967;119:141–6.CrossRef
36.
Petz L. Immunologic cross-reactivity between penicillins and cephalosporins: a review. J Infect Dis. 1978;137:S74–9.PubMedCrossRef
37.
Shibata K, Atsumi T, Itorivchi Y, et al. Immunological cross-reactivities of cephalothin and its related compounds with benzylpenicillin (penicillin G). Nature. 1966;212:419–20.PubMedCrossRef
38.
Abraham GN, Petz LD, Fudenberg HH. Immunohaematological cross-allergenicity between penicillin and cephalothin in humans. Clin Exp Immunol. 1968;3:343–57.PubMed
39.
Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis. Otolaryngol Head Neck Surg. 2007;136(3):340–7.PubMedCrossRef
40.
Pegler S, Healy B. In patients allergic to penicillin, consider second and third generation cephalosporins for life threatening infections. BMJ. 2007;335:991.PubMedCrossRef
41.
Empedrad R, Darter AL, Earl HS, et al. Nonirritating intradermal skin test concentrations for commonly prescribed antibiotics. J Allergy Clin Immunol. 2003;112:629–30.PubMedCrossRef
42.
Goodman EJ, Morgan MJ, Johnson PA, et al. Cephalosporins can be given to penicillin-allergic patients who do not exhibit an anaphylactic response. J Clin Anesth. 2001;13:561–4.PubMedCrossRef
43.
44.
Saxon A, Adelman DC, et al. Imipenem cross-reactivity with penicillin in humans. J Allergy Clin Immunol. 1988;82:213–7.PubMedCrossRef
45.
Atanaskovic-Markovic M, Gaeta F, et al. Tolerability of imipenem in children with IgE-mediated hypersensitivity to penicillins. J Allergy Clin Immunol. 2009;124(1):167–9.PubMedCrossRef
46.
McConnell SA, Penzak SR, et al. Incidence of imipenem hypersensitivity reactions in febrile neutropenic bone marrow transplant patients with a history of penicillin allergy. Clin Infect Dis. 2000;31:1512–4.PubMedCrossRef
47.
Prescott Jr WA, DePestel DD, et al. Incidence of carbapenem-associated allergic-type reactions among patients with versus patients without a reported penicillin allergy. Clin Infect Dis. 2004;38:1102–7.PubMedCrossRef
48.
Sodhi M, Axtell SS, et al. Is it safe to use carbapenems in patients with history of allergy to penicillin? J Antimicrob Chemother. 2004;54:1155–7.PubMedCrossRef
49.
Adkinson Jr NF, Swabb EA, Sugerman AA. Immunology of the monobactam aztreonam. Antimicrob Agents Chemother. 1984;25:93–7.PubMedCrossRef
50.
Saxon A, Hassner A, Swabb EA, et al. Lack of cross-reactivity between aztreonam, a monobactam antibiotic, and penicillin in penicillin-allergic subjects. J Infect Dis. 1984;149:16–22.PubMedCrossRef
51.
Adkinson NF Jr, Wheeler B, Swabb EA. Clinical tolerance of the monobactam aztreonam in penicillin allergic subjects (Abstract WS-26-4). Presented at the 14th International Congress of Chemotherapy, Kyoto, Japan, June 23-28, 1985.
52.
Pimiento P, Martinez G, Mena M, et al. Aztreonam and ceftazidime: evidence of in vivo cross-allergenicity. Allergy. 1998;50:524–5.
53.
de la Fuente Prieto R, Armentia Medina A, Sanchez Palla P, et al. Urticaria caused by sensitization to aztreonam. Allergy. 1993;48:634–6.PubMedCrossRef
54.
Atanaskovic-Markovic M. Educational case series: beta-lactam allergy and cross-reactivity. Ped Allergy Immunol. 2011;22:770–5.CrossRef
55.
Blanca M, Romano A, et al. Update on the evaluation of hypersensitivity reactions to betalactams. Allergy. 2009;64:183–93.PubMedCrossRef
Metadata
Title
Skin Testing For Beta-Lactam Antibiotics: Impact of the Availability of a Major Determinant
Authors
Fatima S. Khan
Michael E. Weiss
Publication date
01-02-2013
Publisher
Current Science Inc.
Published in
Current Allergy and Asthma Reports / Issue 1/2013
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-012-0323-y

Other articles of this Issue 1/2013

Current Allergy and Asthma Reports 1/2013 Go to the issue

BASIC AND APPLIED SCIENCE (M FRIERI, SECTION EDITOR)

Immunology and Clinical Manifestations of Non-Clonal Mast Cell Activation Syndrome

Basic and Applied Science (M Frieri, Section Editor)

Immune Response to Nanomaterials: Implications for Medicine and Literature Review

IMMUNOLOGIC/DIAGNOSTIC TESTS IN ALLERGY (JL SCHMITZ, SECTION EDITOR)

Personalised Medicine and Asthma Diagnostics/Management

IMMUNOLOGIC/DIAGNOSTIC TESTS IN ALLERGY (JL SCHMITZ, SECTION EDITOR)

Update on the Performance and Application of Basophil Activation Tests

Anaphylaxis and Drug Allergy (P Lieberman and S Spector, Section Editors)

Progress in Understanding the Epigenetic Basis for Immune Development, Immune Function, and the Rising Incidence of Allergic Disease

ANAPHYLAXIS AND DRUG ALLERGY (P LIEBERMAN AND S SPECTOR, SECTION EDITORS)

Use of Omalizumab in the Treatment of Food Allergy and Anaphylaxis