title: Alkali-treated penicillin G solution is a better option than penicillin G as an alternative source of minor determinants for penicillin skin test.
abstract: Both benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM) are the recommended standard reagents for penicillin skin testing. However, penicillin G is commonly suggested as an alternative source of minor determinants. This study evaluated the accuracy of penicillin G and alkali-treated penicillin G compared with the standardized MDM for skin testing. Sixty-eight patients with histories of allergies to penicillin or semisynthetic penicillins were skin tested with commercial Kit penicillin allergenic determinants (DAP) (PPL and DAP-MDM; Diater Laboratorios, Madrid, Spain). The in-house MDM (IH-MDM), prepared by alkali-treated aged penicillin, and fresh penicillin G sodium (PGs) were tested alongside DAP-MDM. Positive penicillin skin test results were identified in 22 patients (32.4%) using commercial reagents (PPL+ DAP-MDM) and 19 of them reacted to DAP-MDM alone or together with PPL. The accuracy of IH-MDM and PGs compared with DAP-MDM was 89.7 and 76.5%, respectively. Our study shows that alkali-treated penicillin G is a better option than penicillin G as an alternative source of MDM for skin testing in case the commercialized MDM is not available. Minor determinants play a significant role for penicillin allergy in Thailand and should be included in the penicillin skin test panel to verify suspected cases of penicillin allergy. (ClinicalTrials.gov number: NCT00789217).
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Pongsak
authors.initials: P
authors.lastname: Wangrattanasopon
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Chantaphakul
authors.forename: Supranee
authors.initials: S
authors.lastname: Buranapraditkun
authors.forename: Jettanong
authors.initials: J
authors.lastname: Klaewsongkram
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000468:Alkalies / Q000737:chemistry; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000737:chemistry; D044482:Benzeneacetamides / Q000009:adverse effects / Q000737:chemistry; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000737:chemistry; D011933:Reagent Kits, Diagnostic; D012882:Skin Tests / Q000379:methods*; D013785:Thailand
chemical_list: D000468:Alkalies; D000900:Anti-Bacterial Agents; D044482:Benzeneacetamides; D011933:Reagent Kits, Diagnostic; C509029:benzylpenicilloyl G polylysine; D010400:Penicillin G