Skin tests in the diagnosis of eruptions caused by betalactams

Authors

  • P. Lisi,

    Corresponding author
    1. Allergologic and Environmental Dermatology Unit, Department of Medical and Surgical Specialties, University of Perugia, Policlinic Monteluce, I 06100 Perugia, Italy
    • Paolo Lisi, Dermatolgía allergologica e am bientale, Dipartimento di Specialitá medico-chirurgiche, Policlinico Monteluce, I 06100 Perugia, Italy

    Search for more papers by this author
  • V. Lapomarda,

    1. Allergologic and Environmental Dermatology Unit, Department of Medical and Surgical Specialties, University of Perugia, Policlinic Monteluce, I 06100 Perugia, Italy
    Search for more papers by this author
  • L. Stingeni,

    1. Allergologic and Environmental Dermatology Unit, Department of Medical and Surgical Specialties, University of Perugia, Policlinic Monteluce, I 06100 Perugia, Italy
    Search for more papers by this author
  • D. Assalve,

    1. Allergologic and Environmental Dermatology Unit, Department of Medical and Surgical Specialties, University of Perugia, Policlinic Monteluce, I 06100 Perugia, Italy
    Search for more papers by this author
  • K. Hansel,

    1. Allergologic and Environmental Dermatology Unit, Department of Medical and Surgical Specialties, University of Perugia, Policlinic Monteluce, I 06100 Perugia, Italy
    Search for more papers by this author
  • S. Caraffini,

    1. Allergologic and Environmental Dermatology Unit, Department of Medical and Surgical Specialties, University of Perugia, Policlinic Monteluce, I 06100 Perugia, Italy
    Search for more papers by this author
  • D. Agostinelli

    1. Allergologic and Environmental Dermatology Unit, Department of Medical and Surgical Specialties, University of Perugia, Policlinic Monteluce, I 06100 Perugia, Italy
    Search for more papers by this author

Abstract

The aetiologic evaluation of adverse cutaneous reactions to penicillin's is still not an easy problem to solve. Skin testing is usually earned out intradermally with benzylpenicilloyl polylysine (BPO-PPL) and minor determinant mixture (MDM), but these are often unsuitable for the detection of sensitivity to betalactam antibiotics. 101 selected subjects, with different cutaneous reactions to betalactams and with a clinical history of positive challenge, were skin tested (patch lest, prick test, intradermal test) with a standard betalactam series (amoxycillin, sodium penicillin G, ampicillin, bacampicillin, aztreonam, ceftriazone, BPO-PPL, MDM). 1 or more positive reactions to skin tests, mainly to intradermal tests, were observed in 47.5% of the subjects studied, especially in those with maculopapular eruptions, urticaria/angioedema and drug reactions caused by ampicillin and amoxycillin. Cross-sensitivity was demonstrated in 22.8% of cases and was due almost solely to the semi synthetic penicillin. Finally, to increase the yield in detecting positive patients, it is necessary that ampicillin and amoxycillin be tested in addition to major and minor determinants.

Ancillary