title: [Importance of the benzylpenicillin nucleus and the side chain of the beta-lactams. Demonstration by skin tests and RAST in penicillin allergic patients].
abstract: We studied 30 patients with beta-Lactams allergy demonstrated by clinical findings. The aim of this work was to determine the capacity of the beta-Lactams nucleus and the side chain in the induction of specific IgE to BPO, Ax, Amp, performed by intradermal skin test and RAST. The patients were divided by clinical manifestations in: 1-Accelerated reactions (n:19); and 2-Immediate reactions (n:11). The Prick tests were performed with BPO-PL, Ax-PL, Amp-PL, MDM-BP, MDM-Ax, MDM-Amp. The accelerated group presented BPO-PL (+) in 2 cases, Ax-PL & Amp-PL (+) in 4 cases, and all of the reactives were (+) in 13 out of 19 cases. The immediate group presented MDM-BP (+) in 10 out of 11 cases and MDM-Amp was (+) in 1 out of 11 cases. The RAST's were performed in all patients(n:30). In accelerated group were (+) to BPO-PL in 13 out of 19 cases, to Ax-PL in 3 out of 19 cases, to Amp-PL in 1 out 19 cases, to BPO-PL and Ax-PL on overlap in 1 out of 19 cases, and 1 case was negative to all reactives. The immediate group presented RAST's negatives in 11 out of 11 cases. The control group(n:20) presented Prick (+) to Ax-PL in 1 out of 20 cases, and the others reactives were negatives in all cases. The RAST's to all reactives were (-) in 20 out of 20 subjects. These results indicate that BPO was the most important determinant, and the side chain of the Ax or Amp were others determinants of the beta-Lactams drugs. These determinants induced specific IgE, and in rare occasions appears specific IgE for two different determinants on overlap in the same patient. The intradermal skin testing is the method of choice to study the penicillin allergies, because non satisfactory RAST's have yet been developed for minor determinant-specific IgE antibodies.
authors.affiliation: Sección Alergia e Inmunología, Hospital Misericordia.
authors.forename: J C
authors.initials: JC
authors.lastname: Muiño
authors.forename: C C
authors.initials: CC
authors.lastname: Castro
authors.forename: E G
authors.initials: EG
authors.lastname: Wolff
authors.forename: R M
authors.initials: RM
authors.lastname: Gómez
authors.forename: J R
authors.initials: JR
authors.lastname: Gagliardi
authors.forename: M J
authors.initials: MJ
authors.lastname: Gregorio
authors.forename: R
authors.initials: R
authors.lastname: Rodríguez
authors.forename: M
authors.initials: M
authors.lastname: Palenzuela
authors.forename: I
authors.initials: I
authors.lastname: Ortiz Arzelán
authors.forename: E J
authors.initials: EJ
authors.lastname: Fernández
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000276:immunology; D004342:Drug Hypersensitivity / Q000276:immunology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000302:isolation & purification*; D008297:Male; D010400:Penicillin G / Q000009:adverse effects* / Q000276:immunology; D010406:Penicillins / Q000009:adverse effects* / Q000276:immunology; D012882:Skin Tests
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D007073:Immunoglobulin E; D010400:Penicillin G