The role of penicillin in the pathogenesis of chronic urticaria

Intracutaneous tests with penicilloyl-polylysine (PPL) and benzyl-penicillin G (PG) were performed in 245 patients suffering form chronic recurrent urticaria, including physical urticaria. Positive results were observed in fifty-nine patients (24%). Sera from fifty-seven of these fifty-nine patients were investigated for circulating anti-penicilloyl antibodies by an enzyme-linked immunosorbent assay (ELISA) and a passive haemagglutination test (HA). The results were compared to those form the ELISA and HA in a control group of thirty-five patients who had shown clinical allergic reactions to penicillin and had positive skin tests to PPL and/or PG. The in vitro tests revealed positive results in 12.3% and 37.1% respectively. In forty-three patients the course of the positive intracutaneous tests to penicillin, together with the duration of chronic urticaria, was followed over a period of time up to 3.5 years. In twenty-two out of forty-two patients with positive intracutaneous tests to penicillin, a diet free of dairy products proved to have a curative effect, compared to two out of forty control subjects with chronic urticaria and negative skin tests to penicillin. These studies indicate that penicillin has an important role in the aetiology and maintenance of chronic urticaria.