Positive Skin Test or Specific IgE to Penicillin Does Not Reliably Predict Penicillin Allergy.

Autor: Tannert LK; Odense Research Center for Anaphylaxis, Odense, Denmark; Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark. Electronic address: line.tannert@rsyd.dk., Mortz CG; Odense Research Center for Anaphylaxis, Odense, Denmark; Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark., Skov PS; Odense Research Center for Anaphylaxis, Odense, Denmark; Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark; RefLab Aps., Copenhagen, Denmark., Bindslev-Jensen C; Odense Research Center for Anaphylaxis, Odense, Denmark; Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark.
Jazyk: angličtina
Zdroj: The journal of allergy and clinical immunology. In practice [J Allergy Clin Immunol Pract] 2017 May - Jun; Vol. 5 (3), pp. 676-683.
DOI: 10.1016/j.jaip.2017.03.014
Abstrakt: Introduction: According to guidelines, patients are diagnosed with penicillin allergy if skin test (ST) result or specific IgE (s-IgE) to penicillin is positive. However, the true sensitivity and specificity of these tests are presently not known.
Objective: To investigate the clinical relevance of a positive ST result and positive s-IgE and to study the reproducibility of ST and s-IgE.
Methods: A sample of convenience of 25 patients with positive penicillin ST results, antipenicillin s-IgE results, or both was challenged with their culprit penicillin. Further 19 patients were not challenged, but deemed allergic on the basis of a recent anaphylactic reaction or delayed reactions to skin testing. Another sample of convenience of 18 patients, 17 overlapping with the 25 challenged, with initial skin testing and s-IgE (median, 25; range, 3-121), months earlier (T -1 ), was repeat skin tested and had s-IgE measured (T 0 ), and then skin tested and had s-IgE measured 4 weeks later (T 1 ).
Results: Only 9 (36%) of 25 were challenge positive. There was an increased probability of being penicillin allergic if both ST result and s-IgE were positive at T 0 . Positive ST result or positive s-IgE alone did not predict penicillin allergy. Among the 18 patients repeatedly tested, 46.2% (12 of 25) of positive ST results at T -1 were reproducibly positive at T 0 . For s-IgE, 54.2% (14 of 24) positive measurements were still positive at T 0 and 7 converted to positive at T 1 .
Conclusions: The best predictor for a clinically significant (IgE-mediated) penicillin allergy is a combination of a positive case history with simultaneous positive ST result and s-IgE or a positive challenge result.
(Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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