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Amoxicillin rash in patients with infectious mononucleosis: evidence of true drug sensitization.

Ónodi-Nagy K, Kinyó Á, Meszes A, Garaczi E, Kemény L, Bata-Csörgő Z - Allergy Asthma Clin Immunol (2015)

Bottom Line: Prick tests were negative in all six patients, but the intradermal tests showed positive reactions in four patients.Our data demonstrate that in vitro testing is not sensitive enough in determining drug sensitization to penicillin.In vivo tests should be performed to detect sensitization and indeed with skin tests our results confirmed that sensitization to aminopenicillin may develop within infectious mononucleosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Allergology, University of Szeged, Albert Szent-Györgyi Medical Center, Korányi fasor 6, Szeged, 6720 Hungary.

ABSTRACT

Background: It hasn't been clearly understood yet whether sensitization to antibiotics, the virus itself or transient loss of drug tolerance due to the virus, is responsible for the development of maculopapular exanthems following amoxicillin intake in patients with infectious mononucleosis. We aimed to examine whether sensitization to penicillin developed among patients with skin rash following amoxicillin treatment within infectious mononucleosis.

Methods: Ten patients were investigated for drug sensitization by lymphocyte transformation test and six patients were further tested by prick-, intradermal and patch tests employing the penicillin's main antigens.

Results: Lymphocyte transformation test showed negative results with amoxicillin, while one patient had positive reaction to cefixime. Six patients with suspected sensitization to amoxicillin were then investigated by in vivo tests. Prick tests were negative in all six patients, but the intradermal tests showed positive reactions in four patients.

Conclusions: Our data demonstrate that in vitro testing is not sensitive enough in determining drug sensitization to penicillin. In vivo tests should be performed to detect sensitization and indeed with skin tests our results confirmed that sensitization to aminopenicillin may develop within infectious mononucleosis.

No MeSH data available.


Related in: MedlinePlus

Positive cutaneous response (Penicillin allergenic determinants (DAP) ® test). The in vivo cutaneous investigation was continued with intradermal testing, if the prick tests resulted in negative response at different dilutions. Skin tests were performed using penicillin’s main antigens, major determinants and (PPL) and minor determinant mix (MDM). Cutaneous tests were started with major determinants, the negative control was saline solution. In this case we recognized positive skin reaction to MDM at 1:100 and 1:10 dilutions, which verified the development of sensitization (patient 4).
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Fig2: Positive cutaneous response (Penicillin allergenic determinants (DAP) ® test). The in vivo cutaneous investigation was continued with intradermal testing, if the prick tests resulted in negative response at different dilutions. Skin tests were performed using penicillin’s main antigens, major determinants and (PPL) and minor determinant mix (MDM). Cutaneous tests were started with major determinants, the negative control was saline solution. In this case we recognized positive skin reaction to MDM at 1:100 and 1:10 dilutions, which verified the development of sensitization (patient 4).

Mentions: We performed in vivo cutaneous tests using penicillins in patients with negative LTT to amoxicillin. The remaining patients refused to consent to testing. Prick, intradermal and patch tests were performed using penicillin’s main antigens: major determinant benzylpenicilloyl poly-L-lysine (PPL), minor determinant mix sodium benzylpenicillin, benzylpenicilloic acid, sodium benzylpenicilloate (MDM) from Diater Laboratorios (Penicillin allergenic determinants (DAP) ® test) [12, 13]. We followed the investigation protocol given by the manufacturer [14]. Cutaneous tests were started with major determinants (Figure 2). If the prick tests at different dilutions were negative, the testing was continued with intradermal and then patch tests. Each prick and intradermal tests were read once 20 minutes elapsed since their application. Tests results were also read at 24, 48, 72 and 96 hours for detecting delayed reactions. Patch tests were performed using the powdered culprit drug mixed into vaseline (1:1). Allergens were applied to the upper back in individual round chambers (Curatest®, Spiromed Ltd.). Readings were performed at 48, 72, 96 hours and 7 days [15, 16]. Although skin rashes occurring in mononucleosis are likely delayed type reactions, we performed immediate reading, because clinical history cannot always be trusted, patients will report a delayed reaction which is in fact an immediate one.Figure 2


Amoxicillin rash in patients with infectious mononucleosis: evidence of true drug sensitization.

Ónodi-Nagy K, Kinyó Á, Meszes A, Garaczi E, Kemény L, Bata-Csörgő Z - Allergy Asthma Clin Immunol (2015)

Positive cutaneous response (Penicillin allergenic determinants (DAP) ® test). The in vivo cutaneous investigation was continued with intradermal testing, if the prick tests resulted in negative response at different dilutions. Skin tests were performed using penicillin’s main antigens, major determinants and (PPL) and minor determinant mix (MDM). Cutaneous tests were started with major determinants, the negative control was saline solution. In this case we recognized positive skin reaction to MDM at 1:100 and 1:10 dilutions, which verified the development of sensitization (patient 4).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4362637&req=5

Fig2: Positive cutaneous response (Penicillin allergenic determinants (DAP) ® test). The in vivo cutaneous investigation was continued with intradermal testing, if the prick tests resulted in negative response at different dilutions. Skin tests were performed using penicillin’s main antigens, major determinants and (PPL) and minor determinant mix (MDM). Cutaneous tests were started with major determinants, the negative control was saline solution. In this case we recognized positive skin reaction to MDM at 1:100 and 1:10 dilutions, which verified the development of sensitization (patient 4).
Mentions: We performed in vivo cutaneous tests using penicillins in patients with negative LTT to amoxicillin. The remaining patients refused to consent to testing. Prick, intradermal and patch tests were performed using penicillin’s main antigens: major determinant benzylpenicilloyl poly-L-lysine (PPL), minor determinant mix sodium benzylpenicillin, benzylpenicilloic acid, sodium benzylpenicilloate (MDM) from Diater Laboratorios (Penicillin allergenic determinants (DAP) ® test) [12, 13]. We followed the investigation protocol given by the manufacturer [14]. Cutaneous tests were started with major determinants (Figure 2). If the prick tests at different dilutions were negative, the testing was continued with intradermal and then patch tests. Each prick and intradermal tests were read once 20 minutes elapsed since their application. Tests results were also read at 24, 48, 72 and 96 hours for detecting delayed reactions. Patch tests were performed using the powdered culprit drug mixed into vaseline (1:1). Allergens were applied to the upper back in individual round chambers (Curatest®, Spiromed Ltd.). Readings were performed at 48, 72, 96 hours and 7 days [15, 16]. Although skin rashes occurring in mononucleosis are likely delayed type reactions, we performed immediate reading, because clinical history cannot always be trusted, patients will report a delayed reaction which is in fact an immediate one.Figure 2

Bottom Line: Prick tests were negative in all six patients, but the intradermal tests showed positive reactions in four patients.Our data demonstrate that in vitro testing is not sensitive enough in determining drug sensitization to penicillin.In vivo tests should be performed to detect sensitization and indeed with skin tests our results confirmed that sensitization to aminopenicillin may develop within infectious mononucleosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Allergology, University of Szeged, Albert Szent-Györgyi Medical Center, Korányi fasor 6, Szeged, 6720 Hungary.

ABSTRACT

Background: It hasn't been clearly understood yet whether sensitization to antibiotics, the virus itself or transient loss of drug tolerance due to the virus, is responsible for the development of maculopapular exanthems following amoxicillin intake in patients with infectious mononucleosis. We aimed to examine whether sensitization to penicillin developed among patients with skin rash following amoxicillin treatment within infectious mononucleosis.

Methods: Ten patients were investigated for drug sensitization by lymphocyte transformation test and six patients were further tested by prick-, intradermal and patch tests employing the penicillin's main antigens.

Results: Lymphocyte transformation test showed negative results with amoxicillin, while one patient had positive reaction to cefixime. Six patients with suspected sensitization to amoxicillin were then investigated by in vivo tests. Prick tests were negative in all six patients, but the intradermal tests showed positive reactions in four patients.

Conclusions: Our data demonstrate that in vitro testing is not sensitive enough in determining drug sensitization to penicillin. In vivo tests should be performed to detect sensitization and indeed with skin tests our results confirmed that sensitization to aminopenicillin may develop within infectious mononucleosis.

No MeSH data available.


Related in: MedlinePlus