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Resensitization in suspected penicillin allergy.

Inmaculada Doña1,2, Lucia Guidolin3, Gádor Bogas1,2

  • 1Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.

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Resensitization to penicillin allergy is common, with 14.7% of patients showing positive tests upon re-evaluation. Retesting is crucial for diagnosing penicillin allergy, especially in anaphylaxis cases.

Keywords:
anaphylaxisdrug provocation testpenicillinsresensitizationskin test, specific IgE

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Area of Science:

  • Immunology
  • Clinical Medicine
  • Pharmacology

Background:

  • Diagnosis of penicillin allergy (AR-PEN) is complex due to waning sensitization.
  • Skin tests (STs) and IgE may become negative over time, leading to false negatives.
  • Resensitization can occur, increasing the risk of severe reactions upon re-exposure.

Purpose of the Study:

  • To determine the rate of resensitization in patients with suspected AR-PEN.
  • To analyze the reliability of repeat skin tests (retest) after initial evaluation (IE).

Main Methods:

  • Prospective evaluation of 545 patients with suspected AR-PEN (2017-2020).
  • Initial evaluation included STs and drug provocation tests (DPT) for a subset.
  • Patients with negative initial tests were retested with STs 2-8 weeks later.

Main Results:

  • 14.7% of patients (80/545) showed positive results upon retest (RT+).
  • The rate of RT+ was significantly higher in immediate reactions (21.3%) than non-immediate (6.8%).
  • Anaphylaxis cases had a higher RT+ rate (45.8%), and risk increased with time post-IE and patient age.

Conclusions:

  • A significant rate of resensitization to penicillin allergy necessitates retesting.
  • Retesting should be part of the diagnostic algorithm for immediate penicillin reactions.
  • Early retesting is vital to prevent severe reactions from subsequent penicillin prescriptions.