Diagnosing nonimmediate reactions to penicillins by in vivo tests

Antonino Romano, Marinella Viola, Chiara Mondino, Rosa Pettinato, Marina Di Fonso, Giuseppe Papa, Alberto Venuti, Paolo Montuschi

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background: Maculopapular and urticarial rashes are nonimmediate manifestations common during penicillin treatment; the former often represent cell-mediated hypersensitivity. Our objectives were to assess the incidence of allergy in adults reporting nonimmediate manifestations during penicillin therapy and to evaluate the diagnostic potential of patch tests, delayed-reading skin tests and challenges in such cases. Methods: We used prick and intradermal tests as well as patch tests with penicillin determinants, ampicillin, amoxicillin and any other suspect penicillins. We also performed challenges with the suspect antibiotics. Results: Such antibiotics were aminopenicillins in 93.1% of 259 patients, most of whom had suffered from maculopapular rashes followed by piperacillin (4.2%). Three subjects displayed immediate skin test positivity. Ninety-four subjects showed patch test and delayed intradermal test positivity to the culprit penicillin (90 to aminopenicillins and 4 to piperacillin) and were considered as having had delayed hypersensitivity reactions. Five of the 8 subjects who displayed delayed intradermal test positivity and patch test negativity to the suspect penicillin underwent challenges, 2 reacted positively to the responsible aminopenicillin. Among the remaining 154 with negative results in allergologic tests, 125 agreed to undergo challenges; only 3 reacted. In all, 98 patients - 93 of whom had experienced maculopapular rashes - displayed delayed hypersensitivity (94 to aminopenicillins and 4 to piperacillin). Conclusions: Both patch and intradermal tests are useful in evaluating nonimmediate reactions to penicillins, particularly maculopapular rashes. Patch test and delayed intradermal positivity together indicate delayed hypersensitivity. Intradermal testing appears to be slightly more sensitive than patch testing.

Original languageEnglish
Pages (from-to)169-174
Number of pages6
JournalInternational Archives of Allergy and Immunology
Volume129
Issue number2
DOIs
Publication statusPublished - 2002

Fingerprint

Patch Tests
Penicillins
Intradermal Tests
Exanthema
Piperacillin
Delayed Hypersensitivity
Skin Tests
Hypersensitivity
Anti-Bacterial Agents
Amoxicillin
Ampicillin
Reading
Incidence
Therapeutics

Keywords

  • Challenges
  • Intradermal tests
  • Maculopapular rash
  • Patch tests
  • Penicillins

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Romano, A., Viola, M., Mondino, C., Pettinato, R., Di Fonso, M., Papa, G., ... Montuschi, P. (2002). Diagnosing nonimmediate reactions to penicillins by in vivo tests. International Archives of Allergy and Immunology, 129(2), 169-174. https://doi.org/10.1159/000065876

Diagnosing nonimmediate reactions to penicillins by in vivo tests. / Romano, Antonino; Viola, Marinella; Mondino, Chiara; Pettinato, Rosa; Di Fonso, Marina; Papa, Giuseppe; Venuti, Alberto; Montuschi, Paolo.

In: International Archives of Allergy and Immunology, Vol. 129, No. 2, 2002, p. 169-174.

Research output: Contribution to journalArticle

Romano, A, Viola, M, Mondino, C, Pettinato, R, Di Fonso, M, Papa, G, Venuti, A & Montuschi, P 2002, 'Diagnosing nonimmediate reactions to penicillins by in vivo tests', International Archives of Allergy and Immunology, vol. 129, no. 2, pp. 169-174. https://doi.org/10.1159/000065876
Romano, Antonino ; Viola, Marinella ; Mondino, Chiara ; Pettinato, Rosa ; Di Fonso, Marina ; Papa, Giuseppe ; Venuti, Alberto ; Montuschi, Paolo. / Diagnosing nonimmediate reactions to penicillins by in vivo tests. In: International Archives of Allergy and Immunology. 2002 ; Vol. 129, No. 2. pp. 169-174.
@article{a8df54e389394b07a7768cee9c69a678,
title = "Diagnosing nonimmediate reactions to penicillins by in vivo tests",
abstract = "Background: Maculopapular and urticarial rashes are nonimmediate manifestations common during penicillin treatment; the former often represent cell-mediated hypersensitivity. Our objectives were to assess the incidence of allergy in adults reporting nonimmediate manifestations during penicillin therapy and to evaluate the diagnostic potential of patch tests, delayed-reading skin tests and challenges in such cases. Methods: We used prick and intradermal tests as well as patch tests with penicillin determinants, ampicillin, amoxicillin and any other suspect penicillins. We also performed challenges with the suspect antibiotics. Results: Such antibiotics were aminopenicillins in 93.1{\%} of 259 patients, most of whom had suffered from maculopapular rashes followed by piperacillin (4.2{\%}). Three subjects displayed immediate skin test positivity. Ninety-four subjects showed patch test and delayed intradermal test positivity to the culprit penicillin (90 to aminopenicillins and 4 to piperacillin) and were considered as having had delayed hypersensitivity reactions. Five of the 8 subjects who displayed delayed intradermal test positivity and patch test negativity to the suspect penicillin underwent challenges, 2 reacted positively to the responsible aminopenicillin. Among the remaining 154 with negative results in allergologic tests, 125 agreed to undergo challenges; only 3 reacted. In all, 98 patients - 93 of whom had experienced maculopapular rashes - displayed delayed hypersensitivity (94 to aminopenicillins and 4 to piperacillin). Conclusions: Both patch and intradermal tests are useful in evaluating nonimmediate reactions to penicillins, particularly maculopapular rashes. Patch test and delayed intradermal positivity together indicate delayed hypersensitivity. Intradermal testing appears to be slightly more sensitive than patch testing.",
keywords = "Challenges, Intradermal tests, Maculopapular rash, Patch tests, Penicillins",
author = "Antonino Romano and Marinella Viola and Chiara Mondino and Rosa Pettinato and {Di Fonso}, Marina and Giuseppe Papa and Alberto Venuti and Paolo Montuschi",
year = "2002",
doi = "10.1159/000065876",
language = "English",
volume = "129",
pages = "169--174",
journal = "International Archives of Allergy and Immunology",
issn = "1018-2438",
publisher = "S. Karger AG",
number = "2",

}

TY - JOUR

T1 - Diagnosing nonimmediate reactions to penicillins by in vivo tests

AU - Romano, Antonino

AU - Viola, Marinella

AU - Mondino, Chiara

AU - Pettinato, Rosa

AU - Di Fonso, Marina

AU - Papa, Giuseppe

AU - Venuti, Alberto

AU - Montuschi, Paolo

PY - 2002

Y1 - 2002

N2 - Background: Maculopapular and urticarial rashes are nonimmediate manifestations common during penicillin treatment; the former often represent cell-mediated hypersensitivity. Our objectives were to assess the incidence of allergy in adults reporting nonimmediate manifestations during penicillin therapy and to evaluate the diagnostic potential of patch tests, delayed-reading skin tests and challenges in such cases. Methods: We used prick and intradermal tests as well as patch tests with penicillin determinants, ampicillin, amoxicillin and any other suspect penicillins. We also performed challenges with the suspect antibiotics. Results: Such antibiotics were aminopenicillins in 93.1% of 259 patients, most of whom had suffered from maculopapular rashes followed by piperacillin (4.2%). Three subjects displayed immediate skin test positivity. Ninety-four subjects showed patch test and delayed intradermal test positivity to the culprit penicillin (90 to aminopenicillins and 4 to piperacillin) and were considered as having had delayed hypersensitivity reactions. Five of the 8 subjects who displayed delayed intradermal test positivity and patch test negativity to the suspect penicillin underwent challenges, 2 reacted positively to the responsible aminopenicillin. Among the remaining 154 with negative results in allergologic tests, 125 agreed to undergo challenges; only 3 reacted. In all, 98 patients - 93 of whom had experienced maculopapular rashes - displayed delayed hypersensitivity (94 to aminopenicillins and 4 to piperacillin). Conclusions: Both patch and intradermal tests are useful in evaluating nonimmediate reactions to penicillins, particularly maculopapular rashes. Patch test and delayed intradermal positivity together indicate delayed hypersensitivity. Intradermal testing appears to be slightly more sensitive than patch testing.

AB - Background: Maculopapular and urticarial rashes are nonimmediate manifestations common during penicillin treatment; the former often represent cell-mediated hypersensitivity. Our objectives were to assess the incidence of allergy in adults reporting nonimmediate manifestations during penicillin therapy and to evaluate the diagnostic potential of patch tests, delayed-reading skin tests and challenges in such cases. Methods: We used prick and intradermal tests as well as patch tests with penicillin determinants, ampicillin, amoxicillin and any other suspect penicillins. We also performed challenges with the suspect antibiotics. Results: Such antibiotics were aminopenicillins in 93.1% of 259 patients, most of whom had suffered from maculopapular rashes followed by piperacillin (4.2%). Three subjects displayed immediate skin test positivity. Ninety-four subjects showed patch test and delayed intradermal test positivity to the culprit penicillin (90 to aminopenicillins and 4 to piperacillin) and were considered as having had delayed hypersensitivity reactions. Five of the 8 subjects who displayed delayed intradermal test positivity and patch test negativity to the suspect penicillin underwent challenges, 2 reacted positively to the responsible aminopenicillin. Among the remaining 154 with negative results in allergologic tests, 125 agreed to undergo challenges; only 3 reacted. In all, 98 patients - 93 of whom had experienced maculopapular rashes - displayed delayed hypersensitivity (94 to aminopenicillins and 4 to piperacillin). Conclusions: Both patch and intradermal tests are useful in evaluating nonimmediate reactions to penicillins, particularly maculopapular rashes. Patch test and delayed intradermal positivity together indicate delayed hypersensitivity. Intradermal testing appears to be slightly more sensitive than patch testing.

KW - Challenges

KW - Intradermal tests

KW - Maculopapular rash

KW - Patch tests

KW - Penicillins

UR - http://www.scopus.com/inward/record.url?scp=0036974576&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036974576&partnerID=8YFLogxK

U2 - 10.1159/000065876

DO - 10.1159/000065876

M3 - Article

C2 - 12403935

AN - SCOPUS:0036974576

VL - 129

SP - 169

EP - 174

JO - International Archives of Allergy and Immunology

JF - International Archives of Allergy and Immunology

SN - 1018-2438

IS - 2

ER -