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Selective sensitization to Penicillin V with tolerance to other betalactams

Leticia Sánchez-Morillas, Patricia Rojas-Pérez-Ezquerra, Rosario González-Mendiola

  • 1Servicio de Alergia, Hospital Central de la Cruz Roja, Reina Victoria 22, 28003 Madrid, Spain. lsanchezmorillas@hotmail.com.

Recent Patents on Inflammation & Allergy Drug Discovery
|January 23, 2014
PubMed
Abstract

Insights

This study details a rare case of Penicillin V allergy diagnosed via oral challenge after standard tests were negative. The patient experienced hives and itching from Penicillin V but tolerated other beta-lactams, indicating specific sensitization.

Area of Science:

  • Allergy and Immunology
  • Pharmacology
  • Dermatology

Background:

  • Penicillin G and V share a beta-lactam ring, but differ in their side chains.
  • Penicillin V (phenoxymethylpenicillin) is a derivative of benzylpenicillin.
  • Understanding structural differences is key to allergy diagnosis.

Observation:

  • A 34-year-old man presented with generalized urticaria post-Penicillin V ingestion.
  • Standard allergy workup, including skin prick tests, intradermal tests, and specific IgE, yielded negative results for various beta-lactams.
  • A single-blind oral challenge with Penicillin V confirmed hypersensitivity.

Findings:

  • Skin and serological tests for beta-lactam allergy were negative.
  • The patient developed immediate hypersensitivity symptoms (pruritus, hives) upon oral challenge with 125 mg Penicillin V.
  • Cross-reactivity was not observed, as the patient tolerated amoxicillin, cefuroxime, and ceftazidime.

Implications:

  • Highlights the diagnostic value of oral challenges in suspected drug allergies when in vitro and skin tests are inconclusive.
  • Suggests specific sensitization to Penicillin V is possible despite negative standard allergy testing.
  • Informs clinical practice regarding the safe use of alternative beta-lactams in patients with specific Penicillin V hypersensitivity.

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