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 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Clinical and Translational Allergy
Published in: Clinical and Translational Allergy 1/2017

Open Access 01-12-2017 | Research

Is a positive intracutaneous test induced by penicillin mediated by histamine? A cutaneous microdialysis study in penicillin-allergic patients

Authors: Line K. Tannert, Sidsel Falkencrone, Charlotte G. Mortz, Carsten Bindslev-Jensen, Per Stahl Skov

Published in: Clinical and Translational Allergy | Issue 1/2017

Login to get access

Abstract

Background

Diagnostic workup of penicillin allergy comprises skin testing with penicillins, and patients are deemed allergic if skin test is positive. However, the literature suggests that skin test-positive patients may be challenge-negative, indicating that the skin test may be falsely positive.

Objective

To investigate real-time histamine release from a positive intracutaneous test induced by penicillin in patients with positive and negative challenges to penicillin.

Methods

Skin microdialysis was performed in 21 penicillin-allergic patients with positive skin test, 13 non-allergic volunteers serving as negative controls, and 7 grass pollen-allergic patients serving as positive controls. Histamine was measured by microdialysis after skin test with penicillin/grass/NaCl. Penicillin challenge was subsequently performed in 12 of the patients.

Results

Only 10/21 patients (47.6%) were skin test positive at microdialysis. During microdialysis 13 single intracutaneous tests were positive and histamine was detected in 4/13 occurring in four challenge positive patients. Thirteen/21 patients (61.9%) were deemed allergic to penicillin; eight had positive skin test. Two patients with positive skin test were challenge negative. In grass pollen allergic patients, 7/7 had a positive intracutaneous test to grass and all released histamine in the wheals. All 13 negative controls had negative intracutaneous test to penicillin and no histamine release.

Conclusion

Histamine was only detected in the minority of positive intracutaneous tests with penicillin in penicillin-allergic patients. Other mediators may be involved.
Literature
1.
Torres MJ, Blanca M, Fernandez J, Romano A, Weck A, Aberer W, et al. Diagnosis of immediate allergic reactions to beta-lactam antibiotics. Allergy. 2003;58(10):961–72.CrossRefPubMed
2.
Blanca M, Romano A, Torres MJ, Fernandez J, Mayorga C, Rodriguez J, et al. Update on the evaluation of hypersensitivity reactions to betalactams. Allergy. 2009;64(2):183–93.CrossRefPubMed
3.
Romano A, Blanca M, Torres MJ, Bircher A, Aberer W, Brockow K, et al. Diagnosis of nonimmediate reactions to beta-lactam antibiotics. Allergy. 2004;59(11):1153–60.CrossRefPubMed
4.
Tannert LK, Mortz CG, Skov PS, Bindslev-Jensen C. Positive skin test or specific IgE to penicillin does not reliably predict penicillin allergy. J Allergy Clin Immunol Pract. 2017;5(3):676–83.CrossRefPubMed
5.
Bourke J, Pavlos R, James I, Phillips E. Improving the effectiveness of penicillin allergy de-labeling. J Allergy Clin Immunol Pract. 2015;3(3):365-34e1.CrossRef
6.
Sogn DD, Evans R 3rd, Shepherd GM, Casale TB, Condemi J, Greenberger PA, et al. Results of the National Institute of Allergy and Infectious Diseases 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(5):1025–32.CrossRefPubMed
7.
Goldberg A, Confino-Cohen R. Skin testing and oral penicillin challenge in patients with a history of remote penicillin allergy. Ann Allergy Asthma Immunol. 2008;100(1):37–43.CrossRefPubMed
8.
Solley GO, Gleich GJ, Van Dellen RG. Penicillin allergy: clinical experience with a battery of skin-test reagents. J Allergy Clin Immunol. 1982;69(2):238–44.CrossRefPubMed
9.
Green GR, Rosenblum AH, Sweet LC. Evaluation of penicillin hypersensitivity: value of clinical history and skin testing with penicilloyl-polylysine and penicillin G. A cooperative prospective study of the penicillin study group of the American Academy of Allergy. J Allergy Clin Immunol. 1977;60(6):339–45.CrossRefPubMed
10.
Caubet JC, Kaiser L, Lemaitre B, Fellay B, Gervaix A, Eigenmann PA. The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge. J Allergy Clin Immunol. 2011;127(1):218–22.CrossRefPubMed
11.
Padial A, Antunez C, Blanca-Lopez N, Fernandez TD, Cornejo-Garcia JA, Mayorga C, et al. Non-immediate reactions to beta-lactams: diagnostic value of skin testing and drug provocation test. Clin Exp Allergy. 2008;38(5):822–8.CrossRefPubMed
12.
Confino-Cohen R, Rosman Y, Meir-Shafrir K, Stauber T, Lachover-Roth I, Hershko A, et al. Oral challenge without skin testing safely excludes clinically significant delayed-onset penicillin hypersensitivity. J Allergy Clin Immunol Pract. 2017;5(3):669–75.CrossRefPubMed
13.
14.
Petersen LJ, Church MK, Skov PS. Histamine is released in the wheal but not the flare following challenge of human skin in vivo: a microdialysis study. Clin Exp Allergy. 1997;27(3):284–95.CrossRefPubMed
15.
KringTannert L, Stahl-Skov P, Bjerremann-Jensen L, Maurer M, Bindslev-Jensen C. Cold urticaria patients exhibit normal skin levels of functional mast cells and histamine after tolerance induction. Dermatology. 2012;224(2):101–5.CrossRef
16.
Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, et al. Skin test concentrations for systemically administered drugs—an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68(6):702–12.CrossRefPubMed
17.
Hjortlund J, Mortz CG, Skov PS, Bindslev-Jensen C. Diagnosis of penicillin allergy revisited: the value of case history, skin testing, specific IgE and prolonged challenge. Allergy. 2013;68(8):1057–64.CrossRefPubMed
18.
Petersen LJ. Measurement of histamine release in intact human skin by microdialysis technique. Clinical and experimental findings. Dan Med Bull. 1998;45(4):383–401.PubMed
19.
Pipkorn U, Andersson M. Topical dermal anaesthesia inhibits the flare but not the weal response to allergen and histamine in the skin-prick test. Clin Allergy. 1987;17(4):307–11.CrossRefPubMed
20.
Skov PS, Mosbech H, Norn S, Weeke B. Sensitive glass microfibre-based histamine analysis for allergy testing in washed blood cells. Results compared with conventional leukocyte histamine release assay. Allergy. 1985;40(3):213–8.CrossRefPubMed
21.
Petersen LJ, Mosbech H, Skov PS. Allergen-induced histamine release in intact human skin in vivo assessed by skin microdialysis technique: characterization of factors influencing histamine releasability. J Allergy Clin Immunol. 1996;97(2):672–9.CrossRefPubMed
22.
Petersen LJ. Quantitative measurement of extracellular histamine concentrations in intact human skin in vivo by the microdialysis technique: methodological aspects. Allergy. 1997;52(5):547–55.CrossRefPubMed
23.
Blanca M, Torres MJ, Garcia JJ, Romano A, Mayorga C, de Ramon E, et al. Natural evolution of skin test sensitivity in patients allergic to beta-lactam antibiotics. J Allergy Clin Immunol. 1999;103(5 Pt 1):918–24.CrossRefPubMed
24.
25.
Soter NA, Lewis RA, Corey EJ, Austen KF. Local effects of synthetic leukotrienes (LTC4, LTD4, LTE4, and LTB4) in human skin. J Invest Dermatol. 1983;80(2):115–9.CrossRefPubMed
26.
Wallengren J, Hakanson R. Effects of capsaicin, bradykinin and prostaglandin E2 in the human skin. Br J Dermatol. 1992;126(2):111–7.CrossRefPubMed
27.
Basran GS, Page CP, Paul W, Morley J. Cromoglycate (DSCG) inhibits responses to platelet-activating factor (PAF-acether) in man: an alternative mode of action for DSCG in asthma? Eur J Pharmacol. 1982;86(1):143–4.CrossRefPubMed
28.
Petersen LJ, Brasso K, Pryds M, Skov PS. Histamine release in intact human skin by monocyte chemoattractant factor-1, RANTES, macrophage inflammatory protein-1 alpha, stem cell factor, anti-IgE, and codeine as determined by an ex vivo skin microdialysis technique. J Allergy Clin Immunol. 1996;98(4):790–6.CrossRefPubMed
29.
Metadata
Title
Is a positive intracutaneous test induced by penicillin mediated by histamine? A cutaneous microdialysis study in penicillin-allergic patients
Authors
Line K. Tannert
Sidsel Falkencrone
Charlotte G. Mortz
Carsten Bindslev-Jensen
Per Stahl Skov
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Clinical and Translational Allergy / Issue 1/2017
Electronic ISSN: 2045-7022
DOI
https://doi.org/10.1186/s13601-017-0179-2

Other articles of this Issue 1/2017

Clinical and Translational Allergy 1/2017 Go to the issue

Letter to the Editor

Three cases of anaphylaxis following injection of a depot corticosteroid with evidence of IgE sensitization to macrogols rather than the active steroid

Review

Prediction and prevention of allergy and asthma in EAACI journals (2016)

Editorial

An interpretation of the new international MAP guideline for the management of Milk Allergy in Primary Care

Erratum

Erratum to: Allergen immunotherapy for IgE-mediated food allergy: protocol for a systematic review

Review

Comparison of atopy patch testing to skin prick testing for diagnosing mite-induced atopic dermatitis: a systematic review and meta-analysis

Brief communication

Low percentage of clinically relevant pistachio nut and mango co-sensitisation in cashew nut sensitised children