Skin Testing for Penicillin Allergy: Its Limited Value

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 309-309
Author(s):  
Renee K. Bergner
Keyword(s):  
American Academy ◽  
Skin Testing ◽  
Skin Tests ◽  
Penicillin G ◽  
Study Group ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
American Academy Of Pediatrics ◽  
History Of ◽  
Therapeutic Administration

In its statement, "Anaphylaxis," The American Academy of Pediatrics Committee on Drugs states in part: "If there is a possibility of sensitivity to . . . penicillin, skin testing for immediate hypersensitivity to the agent should be performed prior to its therapeutic administration."1 The Penicillin Study Group of the American Academy of Allergy reported in 1971 that only 17 (30.4%) of 56 patients with a history of immediate (including anaphylactic) reactions to penicillin exhibited positive skin tests to penicillin G.2

Penicillin Hypersensitivity

1979 ◽  
Vol 1 (5) ◽  
pp. 132-158
Keyword(s):  
Skin Test ◽  
Multicenter Study ◽  
Positive Skin Test ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Penicillin G ◽  
Positive Skin ◽  
Positive History ◽  
History Of

A (massive) multicenter study of 3,000 patients has demonstrated that skin tests to penicillin G and penicilloyl-polylysine (PPL-now commercially available) predict and confirm penicillin allergy. Of patients with a history of penicillin reaction, 19% were positive to either, compared to 7% of controls. A history of anaphylaxis led to 46% positive. Of those with a history of urticaria 17% were positive, and those with maculopapular eruptions did not differ from controls (7% positive). Challenge with penicillin led to a reaction in 6% with a positive history (compared to 2% with a negative) and 67% with a combined positive history and positive skin test (to either).

Allergy skin testing: Science or quackery?

PEDIATRICS ◽  
1977 ◽  
Vol 59 (4) ◽  
pp. 495-498
Author(s):  
Gail G. Shapiro ◽  
C. Warren Bierman ◽  
Clifton T. Furukawa ◽  
William E. Pierson
Keyword(s):  
Physical Examination ◽  
American Academy ◽  
Surgical Procedures ◽  
Skin Testing ◽  
Skin Tests ◽  
Elective Surgical Procedures ◽  
American Academy Of Pediatrics ◽  
Telephone Calls ◽  
Allergy Skin Testing

A commentary in Pediatrics in September 19751 condemned procedure-oriented fee schedules because they encouraged and rewarded the abuse of laboratory and elective surgical procedures. Allergy skin testing was included in this list. Letters to the American Academy of Pediatrics and telephone calls to the Chairman of the Section on Allergy of the Academy took issue with this inclusion. The commentary, however, was directed toward physicians and allergy laboratories who abuse skin testing rather than toward the procedure itself. It was directed to those who perform innumerable and casually selected skin tests as a substitute for an appropriate history, physical examination, and carefully selected tests based on that evaluation.

AstraZeneca ChAdOx1-S COVID-19 Vaccine Can Be Safely Administered in Patients with EDTA Allergy

2021 ◽  
Author(s):  
Syed Basharat Ali ◽  
Griffith Perkins ◽  
Dongjae Ryoo ◽  
Maverick Lee ◽  
Matthew Tunbridge ◽  
...  
Keyword(s):  
Skin Testing ◽  
Local Anaesthetics ◽  
Intradermal Test ◽  
Disodium Edta ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
Radiocontrast Media ◽  
Oral Medications ◽  
Ethylenediaminetetracetic Acid ◽  
History Of

Abstract Background: Immediate hypersensitivity reactions to COVID-19 vaccines have been postulated to be linked to their excipients, such as polyethylene glycol (PEG) in Pfizer Comirnaty, or polysorbate 80 and ethylenediaminetetracetic acid (EDTA) in AstraZeneca ChAdOx1-S [recombinant] (Vaxzevria). These excipients are potentially found in a range of other products, including injectable and oral medications as well as intravenous radiocontrast media (RCM) and various cosmetic products.Currently patients with proven excipient allergy may be advised to avoid a COVID-19 vaccine containing that excipient and/or potentially cross-reactive excipients. We present two cases of previously confirmed EDTA anaphylaxis, who had negative Vaxzevria vaccine in-vivo testing and subsequently tolerated the vaccine.Case 1: A patient with history of anaphylaxis to RCM and local anaesthetics (LA) had positive intradermal test (IDT) to EDTA nine years earlier. Skin testing to Vaxzeria vaccine (up to 1:10 IDT), Comirnaty vaccine (up to 1:10 IDT) and EDTA 0.3mg/mL IDT were negative. However, following EDTA 3mg/ml IDT, he developed immediate generalised urticaria without anaphylaxis. Basophil activation testing was negative to disodium EDTA, Vaxzevria and Cominarty vaccines. Given the negative in-vitro and in-vivo testing to Vaxzevria vaccine, he proceeded to Vaxzevria immunisation and tolerated both doses.Case 2: A patient with history of anaphylaxis to RCM had positive skin testing to EDTA and RCM containing EDTA six years earlier. Following referral to COVID19 vaccine clinic, Vaxzevria vaccine (1:10 IDT) and Cominarty vaccine (1:10 IDT) were negative whilst EDTA was positive at 0.3mg/mL IDT. He subsequently tolerated both Vaxzevria vaccinations.Conclusion: Excipient allergy does not necessarily preclude a patient from receiving a vaccine containing that excipient. Allergy testing can help identify excipient-allergic patients who may still tolerate vaccination, which is important in situations where COVID-19 vaccination options are limited.

scholarly journals Sodium metabisulfite hypersensitivity in urticaria

2021 ◽  
Vol 12 (2) ◽  
pp. 106-112
Author(s):  
Beata Sadowska ◽  
Marlena Sztormowska ◽  
Marika Gawinowska ◽  
Marta Chelminska
Keyword(s):  
Skin Testing ◽  
Food Additives ◽  
Oral Challenge ◽  
Skin Tests ◽  
Sodium Metabisulfite ◽  
Positive Skin ◽  
Patch Tests ◽  
Detailed Medical History ◽  
History Of ◽  
Skin Prick Tests

Background: Sodium metabisulfite is a recognized, but rare, trigger of urticaria, wherein the IgE mechanism has been sporadically proven. The aim of this study was to identify the potential reaction to sodium metabisulfite (MBS) based on a placebo-controlled oral challenge in patients with urticaria and suspected hypersensitivity to food additives. Materials and Methods: A total of 110 adult patients (76 females and 34 males with a mean age of 46 years) were included in the study between 2017 and 2019. All subjects underwent MBS skin prick tests (SPT) and patch tests (PT). Patients with a positive skin test or suspected MBS hypersensitivity were qualified for a placebo-controlled oral challenge (OC). Results: Skin testing was positive in 24 patients: SPT in 20% (n = 22), PT in 5% (n = 6). Out of 64 oral challenges, 13 positive results were obtained. Patients with a positive challenge typed sulfite foods twice as often as a culprit compared to those with a negative OC. Conclusions: In patients with urticaria, both the IgE and non-IgE mechanism of MBS hypersensitivity has been demonstrated. Skin tests with a detailed medical history of potentially guilty foods may be helpful in determining sulfite hypersensitivity.

scholarly journals Pre-vaccination allergy testing with COVID-19 mRNA vaccines predicts tolerance

2021 ◽  
Author(s):  
Florian Stehlin ◽  
Rima Mahdi-Aljedani ◽  
Loris Canton ◽  
Véronique Monzambani-Banderet ◽  
Alix Miauton ◽  
...  
Keyword(s):  
Acute Asthma ◽  
Skin Testing ◽  
Skin Tests ◽  
Positive Skin ◽  
Post Vaccination ◽  
Vaccination Protocol ◽  
Acute Asthma Exacerbation ◽  
History Of ◽  
Negative Skin Test ◽  
Dependent Mechanism

Background: The newly developed mRNA-based COVID-19 vaccines can provoke anaphylaxis, possibly induced by polyethylene glycol (PEG) contained in the vaccine. The management of persons with a history of PEG allergy, or with an allergic-like reaction after the first dose remains to be defined.  Methods: We studied two cohorts of individuals: one pre-vaccination, the second post-vaccination. Skin testing was performed with COVID-19 mRNA vaccines. Upon negative skin test, a two-step (10%-90%) vaccination protocol was performed. Positive skin tests were confirmed with basophil activation tests (BAT). Vaccine-sensitized patients were offered a five-step induction protocol. Results: We identified 187 patients with high-risk profiles for developing anaphylaxis. In parallel, among 385’926 doses of vaccine, 87 allergic-like reactions were reported to our division for further investigations: 18/87 (21%) were consistent with anaphylaxis, 78/87 (90%) were female, and 47/87 (54%) received the BNT162b2 mRNA vaccine. Vaccine skin tests were negative in 96% and 76% in the pre- and post-vaccination cohorts, respectively. A two-step vaccination was tolerated in 232/236 (98%) of individuals with negative tests. Four individuals experienced acute asthma exacerbation during the two-step challenge. Vaccine-positive skin tests were consistently confirmed by BAT; CD63 and CD203c expression was selectively inhibited with ibrutinib, suggesting an IgE-dependent mechanism. Finally, 13 sensitized patients were successfully vaccinated with a five-step vaccination protocol. Conclusion: A two-step 10%-90%-vaccination protocol can be safely administered upon negative skin testing. Yet, it should be delayed in individuals with poorly controlled asthma. Importantly, mRNA vaccine sensitized individuals may receive a five-step vaccination protocol.

OUR CHALLENGES FOR THE 70'S President's Address, 1970

PEDIATRICS ◽  
1971 ◽  
Vol 47 (2) ◽  
pp. 465-469
Author(s):  
Russell W. Mapes
Keyword(s):  
American Academy ◽  
General Medicine ◽  
Vice President ◽  
Medical Community ◽  
Great Promise ◽  
Quality Health Care ◽  
American Academy Of Pediatrics ◽  
Quality Health ◽  
History Of ◽  
Organized Medicine

For any national organization striving to keep pace with increasingly diverse responsibilities and objectives, there are appropriate times when that organization must pause, reflect, and project before moving forward to meet the goals to which it has dedicated its programs and priorities. This year marks the 40th anniversary of the American Academy of Pediatrics. It was June 23, 1930 that 35 pediatricians met in Harper Hospital in Detroit to establish the Academy as the organization to speak for the interests and health of children, as well as the interests of its pediatric members. This year also marks the beginning of a new decade, a decade which holds great promise for the future of pediatrics but a decade which also presents significant challenges which we must meet if we are to deliver quality health care to all children. The American Academy of Pediatrics is indeed fortunate to be able to draw from the accomplishments of a progressive history of achievement, distinguished by the vision of its early founders. In the 1920's the medical community widely predicted that pediatrics was disappearing as a specialty, that in a few years it would merge into the field of general medicine. Concern was also expressed that pediatrics was not sufficiently represented in the echelons of organized medicine and, consequently, the cause of child health was not being served adequately. To pediatricians like Isaac A. Abt, the first president of the Academy, to John L. Morse, its first vice-president, and to Clifford G. Grulee, the Academy's pioneering executive director, these were very real challenges, but they were not causes for pessimism or defeatism.

scholarly journals Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis

Heliyon ◽  
2021 ◽  
pp. e08401
Author(s):  
Wasurat Sungworn ◽  
Orathai Theankeaw ◽  
Aree Jameekornrak Taweechue ◽  
Chamard Wongsa ◽  
Torpong Thongngarm ◽  
...  
Keyword(s):  
Skin Testing ◽  
Skin Tests ◽  
History Of

THE CUTANEOUS REACTION TO EGGWHITE

PEDIATRICS ◽  
1959 ◽  
Vol 24 (6) ◽  
pp. 1009-1015
Author(s):  
Richard L. London ◽  
Jerome Glaser
Keyword(s):  
Skin Test ◽  
Skin Testing ◽  
Intradermal Test ◽  
Skin Tests ◽  
Etiologic Factor ◽  
Initial Reaction ◽  
Age Group ◽  
Positive Skin ◽  
Clinical Sensitivity ◽  
Number Of Patients

A study of 400 allergic patients of all ages, who were skin tested with eggwhite, is reported. The authors agree with those who believe that a positive reaction in infants who have in no known way been exposed to eggwhite after birth is in all probability due to intrauterine sensitization. There is a possibility, however, that some reactions to eggwhite may be due to a primary histamine or serotonin releasing substance present in the eggwhite which has no relationship to antigen-antibody reaction. The circumstances under which this takes place are not known. In all age groups the family history was positive in about 65% of cases. It was surprising to find, in view of previous opinions, that in the youngest age group (infants up to 2 years of age), the skin test was positive in less than half the patients (42%) in the presence of clinical sensitivity. It was also unexpected to find that the number of patients clinically sensitive to eggwhite but giving negative skin tests increased as age advanced. This justifies the common practice of eliminating egg as a trial measure in the diet of the first age group, regardless of the results of skin testing, and suggests that this should be done in any age group where food is considered a possible etiologic factor. In the youngest age group somewhat more than one-third (34%) of the patients reacted positively to eggwhite but were not clinically sensitive. This finding was completely unexpected as it had been thought that in this age group a positive skin test to eggwhite was practically pathognomonic of clinical sensitivity. In this study more positive reactions in children to eggwhite were obtained (70.5%) than in a somewhat comparable series where the incidence was much less (20%). We attribute this to the fact that in our series both scratch and intradermal tests were made while in the other series only scratch tests were done. This reflects the greater sensitivity of the intradermal test. Only about half the patients of all ages who react to eggwhite are also clinically sensitive. Attention is drawn to a theory which explains why a positive cutaneous test to a food, as eggwhite, may be clinically significant in atopic dermatitis even though the test (wheal reaction) does not reproduce the type of dermatitis being studied. There was no definite evidence, because the number of cases studied is far too small, to indicate that the severity of asthma which may ultimately develop in infants not asthmatic at the time of skin testing is proportional to the strength of the initial reaction to eggwhite.

ACCEPTANCE OF THE PRESIDENCY OF THE AMERICAN ACADEMY OF PEDIATRICS

PEDIATRICS ◽  
1969 ◽  
Vol 43 (1) ◽  
pp. 129-130
Keyword(s):  
Head Start ◽  
American Academy ◽  
American People ◽  
American Academy Of Pediatrics ◽  
Temporal Pressure ◽  
History Of ◽  
One Year ◽  
The Many

To be selected as President of the American Academy of Pediatrics is the greatest honor that could be given me. I approach this year with humility and pledge my best efforts. Never before in the brief history of the Academy has the pressure of time been so enormous and demanded as much immediate vigorous effort as now for the welfare of children. The many problems accompanied by this temporal pressure need no enumeration here. Dr. Logan has mentioned several. With each one, the degree of urgency and the length of time needed to accomplish realistic goals need evaluation. The fact that many problems will take years or decades to solve makes no less important the necessity to address ourselves to them now, before the welfare of a generation of children suffers irrevocably, or before alternative and less desirable solutions are imposed by government or other agencies. The American people are impatient. Witness only Head Start. The Administration was impatient to start the operation before it was pretested so that one year crop of 5 year olds would not be deprived of help. Many Fellows of the Academy, by the same token, have been impatient because the health aspects are not still functioning smoothly. If Head Start works well across the country in 10 years, it will have been a notable achievement. These factors of temporal pressure and impatience disturb pediatricians. Our training as scientists, which advocates careful and deliberate study of problems, makes us distrust hasty diagnosis or ill-considered therapy.

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