PMID- 30248407
OWN - NLM
STAT- MEDLINE
DCOM- 20190729
LR  - 20190729
IS  - 1534-4436 (Electronic)
IS  - 1081-1206 (Linking)
VI  - 121
IP  - 5
DP  - 2018 Nov
TI  - Penicillin minor determinants: History and relevance for current diagnosis.
PG  - 537-544
LID - S1081-1206(18)31206-7 [pii]
LID - 10.1016/j.anai.2018.09.459 [doi]
AB  - OBJECTIVE: To review the history of the penicillin minor determinants and 
      evaluate their relevance for current diagnosis. DATA SOURCES: Skin testing to 
      detect immunoglobulin E (IgE) sensitivity to penicillins in patients with a 
      history of penicillin allergy has been the subject of more than 55 years of 
      published research involving tens of thousands of patients. STUDY SELECTIONS: 
      Selection of data was based on its relevance to the objective of this article. 
      RESULTS: It was established early on that testing with the major penicilloyl 
      determinant using the polyvalent penicilloyl-polylysine (PPL) is negative in a 
      substantial portion (10% to 64%, including recent increases) of those at risk for 
      immediate hypersensitivity reactions. A variety of minor penicillin determinants 
      are clinically significant in that their use in skin testing is essential to 
      detect all those at risk. In particular, a minor determinant mixture of 
      benzylpenicillin, benzylpenicilloate, and benzylpenilloate, used in conjunction 
      with PPL, has been shown in numerous studies to achieve an average negative 
      predictive value (NPV) of 97.9% in history-positive patients. Benzylpenicillin 
      alone, as the sole minor determinant, leaves many skin test-positive patients 
      undiscovered. Use of amoxicillin as an additional minor determinant reagent 
      appears to identify another 2% to 8% of skin test-positive patients in some 
      populations. CONCLUSION: IgE skin testing, using both the major and appropriate 
      minor determinants of penicillin, can identify, with a high degree of reliability 
      (NPV  approximately 97%), penicillin allergy history-positive patients who can receive 
      beta-lactam antibiotics without concern for serious acute allergy, including 
      anaphylaxis. The few false-negative skin tests reported globally are largely 
      confined to minor, self-limited cutaneous reactions.
CI  - Copyright (c) 2018. Published by Elsevier Inc.
FAU - Adkinson, N Franklin Jr
AU  - Adkinson NF Jr
AD  - Division of Allergy & Clinical Immunology, Johns Hopkins Asthma & Allergy Center, 
      Baltimore, Maryland; AllerQuest LLC, Plainville, Connecticut. Electronic address: 
      Fadkinso@jhmi.edu.
FAU - Mendelson, Louis M
AU  - Mendelson LM
AD  - AllerQuest LLC, Plainville, Connecticut; University of Connecticut School of 
      Medicine, New England Food Allergy Center, Farmington, Connecticut.
FAU - Ressler, Charlotte
AU  - Ressler C
AD  - AllerQuest LLC, Plainville, Connecticut; University of Connecticut School of 
      Medicine, Farmington, Connecticut.
FAU - Keogh, John C
AU  - Keogh JC
AD  - AllerQuest LLC, Plainville, Connecticut; Keogh Medical Writing, LLC, Guilford, 
      Connecticut.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20180921
PL  - United States
TA  - Ann Allergy Asthma Immunol
JT  - Annals of allergy, asthma & immunology : official publication of the American 
      College of Allergy, Asthma, & Immunology
JID - 9503580
RN  - 0 (Penicillins)
RN  - 37341-29-0 (Immunoglobulin E)
MH  - Anaphylaxis
MH  - Drug Hypersensitivity/*diagnosis
MH  - Humans
MH  - Immunoglobulin E
MH  - Penicillins/*adverse effects/*immunology
MH  - Predictive Value of Tests
MH  - Skin Tests
EDAT- 2018/09/25 06:00
MHDA- 2019/07/30 06:00
CRDT- 2018/09/25 06:00
PHST- 2018/09/11 00:00 [received]
PHST- 2018/09/18 00:00 [revised]
PHST- 2018/09/18 00:00 [accepted]
PHST- 2018/09/25 06:00 [pubmed]
PHST- 2019/07/30 06:00 [medline]
PHST- 2018/09/25 06:00 [entrez]
AID - S1081-1206(18)31206-7 [pii]
AID - 10.1016/j.anai.2018.09.459 [doi]
PST - ppublish
SO  - Ann Allergy Asthma Immunol. 2018 Nov;121(5):537-544. doi: 
      10.1016/j.anai.2018.09.459. Epub 2018 Sep 21.