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Retrospective case series analysis of penicillin allergy testing in a UK specialist regional allergy clinic.

Richter, A G and Wong, G K Y and Goddard, S and Heslegrave, J and Derbridge, C and Srivastava, S and Diwakar, L and Huissoon, A P and Krishna, M T (2011) Retrospective case series analysis of penicillin allergy testing in a UK specialist regional allergy clinic. Journal of clinical pathology, 64 (11). pp. 1014-8. ISSN 1472-4146. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://jcp.bmj.com/content/64/11/1014.long

Abstract

INTRODUCTION

Penicillin allergy is the most common drug allergy. Skin testing for the major (PPL) and minor determinants (MDMs) of penicillin offers increased sensitivity and specificity over in vitro testing alone. Following a worldwide absence of reagents, a new kit was licensed in the UK in 2008 (Diater, Spain) and this report evaluates its use in a UK specialist allergy clinic.

METHODS

Prospective data on 50 consecutive patients tested with the new reagents were collected. The departmental protocol is adapted from the 2003 EAACI position paper.

RESULTS

14% (7/50) and 12% (6/50) of patients were diagnosed with immediate and non-immediate reactions respectively. The negative predictive value of the PPL and MDM reagents at the neat concentration for an immediate reaction was 93% (true negatives 37, false negatives 3). Two patients experienced systemic reactions to DPT in the absence of demonstrable specific IgE. None of the patients were diagnosed using skin prick testing alone or at lower concentrations of IDT. Five patients were diagnosed at the IDT stage and two at the DPT stage in the absence of demonstrable specific IgE. Six patients were diagnosed with non-immediate reactions, two on IDT alone and four following IDT and DPT.

CONCLUSION

The new PPL and MDM determinants offer enhanced sensitivity when evaluating β-lactam hypersensitivity; however, there are limitations to the current testing regimens. The UK would benefit from local guidelines, which incorporate the new reagents and acknowledge the high amoxicillin prescription rate and the relatively lower specialist-to-patient ratio in this country.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: QW Microbiology. Immunology
QY Clinical pathology
WD Diseases and disorders of systemic, metabolic or environmental origin > WD300 Hypersensitivity. Allergy
Divisions: Clinical Support > Pathology
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 02 Dec 2014 11:12
Last Modified: 02 Dec 2014 11:12
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/706

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