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Anaphylaxis is a severe, life-threatening hypersensitivity reaction mediated by Immunoglobulin E (IgE) antibodies. When IgE binds to allergens, it triggers the release of mediators– histamine, leukotrienes, and prostaglandins from mast cells and basophils. These mediators cause vasodilation, edema, and inflammation, leading to various symptoms.The primary allergens causing anaphylaxis include food items (e.g., peanuts, shellfish), drugs (e.g., penicillin, asparaginase, corticotropin,...
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Drug-related allergies are immune-mediated responses triggered by the administration of pharmacological agents. These hypersensitivity reactions are classified based on the immune mechanisms involved. The four primary types—Type I, II, III, and IV—are mediated by different immunological pathways and exhibit distinct clinical manifestations.Type I Hypersensitivity/ IgE-Mediated Reactions: Immunoglobulin E (IgE) immediately mediates Type I hypersensitivity reactions. Upon initial...
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Understanding Selective Aminopenicillin Allergy: Findings from a Long-Term Case Series.

Blanca Noguerado-Mellado1,2, Patricia Quijada Morales3,4, Gema Salas Parra3,4

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Selective aminopenicillin allergy affects 12.5% of patients, often presenting with immediate reactions. Testing confirms safe use of penicillin V, aiding antibiotic stewardship.

Keywords:
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Area of Science:

  • Allergy and Immunology
  • Pharmacology
  • Clinical Medicine

Background:

  • β-lactam antibiotics are widely used but antibiotic allergy labels can limit treatment options.
  • Selective hypersensitivity to specific β-lactam subclasses, like aminopenicillins, requires precise diagnosis.

Purpose of the Study:

  • To characterize clinical features and diagnostic outcomes of selective aminopenicillin hypersensitivity.
  • To evaluate the diagnostic utility of various allergy testing methods.

Main Methods:

  • Retrospective analysis of 1,340 patients evaluated for β-lactam allergy (2018-2024).
  • Standardized allergy work-up including skin tests, specific IgE, and drug challenge tests (DCT) with amoxicillin or amoxicillin-clavulanic acid.
  • Assessment of phenoxymethylpenicillin (penicillin V) tolerance during DCT.

Main Results:

  • 167 patients (12.5%) had confirmed selective aminopenicillin allergy, predominantly middle-aged women with immediate reactions (urticaria/angioedema, anaphylaxis).
  • Intradermal testing and DCT were most informative; specific IgE had minimal diagnostic contribution.
  • All patients tolerated penicillin V during DCT, indicating selective sensitization.

Conclusions:

  • Selective aminopenicillin allergy is clinically relevant, necessitating comprehensive diagnostic approaches.
  • Diagnostic algorithms including intradermal testing and DCT are crucial for accurate diagnosis.
  • Safe use of penicillin V and potentially other β-lactams can be confirmed in selective aminopenicillin-allergic patients, improving antibiotic stewardship.