Aminopenicillin allergy
Institute of Internal and Geriatric Medicine, Catholic
University of St Cuore, Rome, Italy
Correspondence to: Dr Antonino Romano, Ambulatorio di Allergologia, Complesso Integrato Columbus, Via della Pineta Sacchetti 506, 00168 Rome, Italy.
Accepted 13 January 1997
Eighty two children with histories of maculopapular or
urticarial rashes during aminopenicillin treatment underwent skin
tests, patch tests, radioallergosorbent assays and, in some cases, oral challenges. Hypersensitivity was diagnosed in eight (9.8%): immediate in four with urticarial reactions and delayed (that is cell mediated) in four with maculopapular rashes. In 49 children (38 with
maculopapular eruptions, 11 with urticarial/angiooedematous
reactions), negative allergologic findings were confirmed using oral
challenges with the suspected drug. Maculopapular rashes may reflect
delayed hypersensitivity to aminopenicillins, which can be diagnosed on
the basis of late intradermal reactions and/or patch test positivity.
The allergen panel must include the suspected aminopenicillin itself,
as many cases are side chain specific. Most patients with urticarial
reactions (more typical of immediate hypersensitivity) will also react
to penicilloyl polylysine and minor determinant mixture. The time elapsed between the reaction and testing must be considered if negative
results emerge, because IgE mediated sensitivity (unlike cell mediated
forms) declines in the absence of antigen exposure.
© 1997 by Archives of Disease in Childhood
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