Premium
Combined in vivo and in vitro approach for the characterization of penicillin‐specific polyclonal lymphocyte reactivity: tolerance tests with safe penicillins instead of challenge with culprit drugs
Author(s) -
Sachs B.,
Al Masaoudi T.,
Merk H.F.,
Erdmann S.
Publication year - 2004
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.2004.06238.x
Subject(s) - penicillin , sensitization , in vivo , medicine , antibiotics , polyclonal antibodies , in vitro , immunology , pharmacology , microbiology and biotechnology , chemistry , antibody , biology , biochemistry
Summary Background Amino‐penicillins are a major cause of delayed‐type reactions to penicillins. Objectives The aim of this study was to establish a diagnostic approach for the characterization of the individual penicillin‐specific polyclonal lymphocyte reactivity in order to detect side chain‐specific sensitization to amino‐penicillins. Patients can then be advised to undergo a tolerance test with safe penicillins instead of provocation with culprit penicillins for confirmation of penicillin allergy. Methods We investigated penicillin‐specific polyclonal lymphocyte reactivity in nine patients with delayed‐type reactions to amino‐penicillins by a combined in vivo (patch, prick and intracutaneous tests with delayed readings) and in vitro (lymphocyte transformation test, LTT) approach. Results A combination of LTT and skin tests improved the sensitivity for the characterization of penicillin‐specific polyclonal lymphocyte reactivity and allowed the detection of three different patterns of lymphocyte reactivity. Four patients showed a side chain‐specific sensitization to amino‐penicillins in vivo and in vitro and were advised to undergo tolerance tests with safe penicillins. Two patients agreed and were exposed to parenteral benzyl‐penicillin and oral phenoxymethyl‐penicillin which they tolerated without complications. Conclusions These data suggest that a combined in vivo and in vitro approach is helpful for the detection of side chain‐specific sensitization to amino‐penicillins. Patients with such sensitization are very likely to tolerate safe penicillins, thereby expanding their therapeutic options when antibiotic treatment is required.