The role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivity
Background: In the evaluation of patient-reported penicillin allergy labels (PALs), the utility of skin testing to the penicillin major determinant, known as penicilloyl polylysine (PPL), and to the minor determinant mixture (MDM), has been questioned. Methods: A review of a clinical antibiotic alle...
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Elsevier
2025-06-01
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| Series: | World Allergy Organization Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1939455125000407 |
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| author | Daniel G. Lapirow, MD Sara Vogrin, MBiostat Joseph F. De Luca, MBBS Jack D. Godsell, MBBS Jason A. Trubiano, MBBS, PhD |
| author_facet | Daniel G. Lapirow, MD Sara Vogrin, MBiostat Joseph F. De Luca, MBBS Jack D. Godsell, MBBS Jason A. Trubiano, MBBS, PhD |
| author_sort | Daniel G. Lapirow, MD |
| collection | DOAJ |
| description | Background: In the evaluation of patient-reported penicillin allergy labels (PALs), the utility of skin testing to the penicillin major determinant, known as penicilloyl polylysine (PPL), and to the minor determinant mixture (MDM), has been questioned. Methods: A review of a clinical antibiotic allergy database from April 2015 to December 2023 at Austin Health (Melbourne, Australia) was performed. Patients with PALs who underwent skin prick testing (SPT) and intradermal testing (IDT) to a previously-published standardised beta-lactam panel were selected. Those with positive SPT or IDT to PPL and/or MDM were identified. Results: A total of 1316 individuals were included in our analysis. Positive skin testing to any reagent was recorded for 168/1316 (12.77%). Positive results to PPL and/or MDM were recorded for 26/1316 (1.98%), including 6 with isolated positive results to PPL and/or MDM, and 20 with additional positive skin testing to at least 1 native penicillin. The number needed to test to confirm 1 additional penicillin allergy with the use of PPL and MDM was calculated at 217.39. Immediate hypersensitivities were reported by all 6 individuals testing positive to the penicillin determinants alone, including 4 with anaphylaxis. Conclusion: These results suggest limited yield in the routine inclusion of PPL and MDM in skin testing panels, particularly in evaluating delayed hypersensitivities. Restricting their use to select cohorts, such as those with anaphylaxis, may prove more efficient and cost-effective. |
| format | Article |
| id | doaj-art-29e1ca9f5cda42bab1a43d148a0ae7f1 |
| institution | DOAJ |
| issn | 1939-4551 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Allergy Organization Journal |
| spelling | doaj-art-29e1ca9f5cda42bab1a43d148a0ae7f12025-08-20T03:21:51ZengElsevierWorld Allergy Organization Journal1939-45512025-06-0118610106310.1016/j.waojou.2025.101063The role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivityDaniel G. Lapirow, MD0Sara Vogrin, MBiostat1Joseph F. De Luca, MBBS2Jack D. Godsell, MBBS3Jason A. Trubiano, MBBS, PhD4Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Melbourne, VIC, Australia; Corresponding author. Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Melbourne, VIC, AustraliaCentre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Melbourne, VIC, AustraliaCentre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Melbourne, VIC, Australia; Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, VIC, AustraliaCentre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Melbourne, VIC, Australia; Department of Infectious Diseases, At the Peter Doherty Institute for Infection and Immunity, Melbourne Medical School, University of Melbourne, VIC, AustraliaBackground: In the evaluation of patient-reported penicillin allergy labels (PALs), the utility of skin testing to the penicillin major determinant, known as penicilloyl polylysine (PPL), and to the minor determinant mixture (MDM), has been questioned. Methods: A review of a clinical antibiotic allergy database from April 2015 to December 2023 at Austin Health (Melbourne, Australia) was performed. Patients with PALs who underwent skin prick testing (SPT) and intradermal testing (IDT) to a previously-published standardised beta-lactam panel were selected. Those with positive SPT or IDT to PPL and/or MDM were identified. Results: A total of 1316 individuals were included in our analysis. Positive skin testing to any reagent was recorded for 168/1316 (12.77%). Positive results to PPL and/or MDM were recorded for 26/1316 (1.98%), including 6 with isolated positive results to PPL and/or MDM, and 20 with additional positive skin testing to at least 1 native penicillin. The number needed to test to confirm 1 additional penicillin allergy with the use of PPL and MDM was calculated at 217.39. Immediate hypersensitivities were reported by all 6 individuals testing positive to the penicillin determinants alone, including 4 with anaphylaxis. Conclusion: These results suggest limited yield in the routine inclusion of PPL and MDM in skin testing panels, particularly in evaluating delayed hypersensitivities. Restricting their use to select cohorts, such as those with anaphylaxis, may prove more efficient and cost-effective.http://www.sciencedirect.com/science/article/pii/S1939455125000407PenicillinAllergySkin prick testingIntradermal testingPenicilloyl polylysineMinor determinant mixture |
| spellingShingle | Daniel G. Lapirow, MD Sara Vogrin, MBiostat Joseph F. De Luca, MBBS Jack D. Godsell, MBBS Jason A. Trubiano, MBBS, PhD The role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivity World Allergy Organization Journal Penicillin Allergy Skin prick testing Intradermal testing Penicilloyl polylysine Minor determinant mixture |
| title | The role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivity |
| title_full | The role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivity |
| title_fullStr | The role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivity |
| title_full_unstemmed | The role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivity |
| title_short | The role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivity |
| title_sort | role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivity |
| topic | Penicillin Allergy Skin prick testing Intradermal testing Penicilloyl polylysine Minor determinant mixture |
| url | http://www.sciencedirect.com/science/article/pii/S1939455125000407 |
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