What is a non type 1 penicillin allergy
In the period September 2003 to October 2013, our serum bank contains samples from 2791 adult patients with suspected penicillin allergy, who had performed measurements of s-IgE to penicillins. Hereof a entire of 287 adult patients had a positive s-IgE to one or more penicillins (benzylpenicillin (pen G), phenoxymethylpenicillin (pen V), ampicillin (AMP), amoxicillin (AX)).
Serum elimination half-life (T½) of s-IgE (pen G, V, AMP, AX)
A entire of 29 patients (10 men and 19 women) had 3 or more measurements of s-IgE over a period of up to 59 months. These were included for determination of T½ of s-IgE (pen G, V, AMP, AX), Figure 1.
The median level of s-IgE measurements was 3 measurements (range 3 – 15 measurements). There were no demographic differences between the patients included and the patients with less than three IgE-measurements not included.
Further no demographic differences were found between the patients with positive s-IgE and the patients with negative s-IgE (p > 0.05). The most frequently reported symptoms were urticaria and/or angioedema (17 cases, 58.6%), unclassified cutaneous rash (11 cases, 37.9%) and anaphylaxis (1 case, 3.5%). Pen V was the culprit drug in most cases, 21 (72.4%), the remaining reacting to dicloxacillin (DX) (4 cases, 13.8%), AX (3 cases, 10.3%) and unknown in one case (3.5%).
Penicillin challenge in patients with previous positive specific IgE to penicillins
The serum bank contained sera from forty-two patients followed prospectively with repeated measurements of s-IgE that had reverted to negative test results.
Of these twenty-two (12 men and 10 women) agreed to participate in the present study. Every patients had negative skin prick test (SPT) and intracutaneous test (ICT) to penicillins prior to penicillin challenge, Figure 1.
The β-lactam eliciting the initial reaction (culprit drug) was pen V in 15 cases (62.5%), AX in 5 (20.8%) and DX in 2 (8.3%).
According to the history reactions commencing within 1 h after drug intake were classified as immediate reactions (IR) and occurred in 7 patients. Reactions commencing 1 h or longer after drug intake were classified as nonimmediate reactions (NIR) and seen in 15 patients. Twelve of the 22 patients reported urticaria and/or angioedema (6 IR, 6 NIR) and 10 patients with unclassified cutaneous rash (1 IR, 9 NIR).
Sixteen of the 22 patients had experienced their initial clinical reaction within one year prior to measurement of the positive s-IgE (thirteen even within 6 months), two within 1–5 years and 4 more than five years prior to blood sampling.
All patients showed undetectable levels of s-IgE at the time of penicillin challenge. The challenge tests were performed according to procedures in our two previous studies [1, 2], with the modifications described in Figure 2a + 2b. At visit 1, a titrated challenge with penicillin was performed by intravenous injection of pen G from 100 IE to 1.000.000 IE in 10-fold increments and 20 min interval, followed by istration of a single oral dose of 400 mg pen V 20 min after the final i.v.
dose. If negative, the patient was at visit 2 given the first two doses (80 mg followed by 800 mg 30 min later) of a 7-day course of pen V in the clinic. If this challenge was negative, the patient continued with 800 mg t.i.d. at home. If the above challenges with pen G and V proved negative and if the case history or previous positive specific IgE pointed to a reaction to a diverse β-lactam antibiotic, the patient was subsequently challenged with the culprit drug (AX, AMP, DX) in a titrated oral protocol (visit 3). Three doses were istered with 30-min. interval (5, 50 and 500 mg). If negative, the patient was at visit 4 given the first dose of a 7-day course of culprit drug (500 mg) followed by dosing (500 mg b.i.d.
(AMP, AX)), and (500 mg t.i.d. (DX)) at home. In case of a positive reaction (positive challenge or positive s-IgE) further challenges were terminated. Blood samples for determination of s-IgE were drawn at visit −1, 0, 1, 2, 3, 4 and four weeks after each visit. In case of renewed positive s-IgE after any of the visits, the investigation was stopped and the patient was followed with measurement of s-IgE with 3–6 months interval.
The Regional Scientific Ethical Committees for Southern Denmark has approved the study (approval number S-20100091).
Every patients gave written informed consent for the study as well as consenting to storage of their blood in the serum bank.
Measurement of specific IgE to penicillins (s-IgE)
S-IgE levels to pen G, pen V, AMP, AX and MDM (minor determinant mix) were measured using ImmunoCAP (ThermoFisher Scientific, Uppsala, Sweden). A positive result was defined as a value ≥ 0.35 kU/L. Entire IgE levels were measured in 20 of the 22 patients included in the penicillin challenge in patients with previous IgE sensitization to penicillins (ThermoFischer Scientific, Uppsala, Sweden).
Serum elimination half-life (T½) of s-IgE (pen G, V, AMP, AX)
Determination of the elimination half-life (T½) of s-IgE was calculated using WinNonlin 6.3 (Pharsight, Mountain View, CA, USA).
T½ was calculated by the following equation: T½ = ln /k, where k is the positive worth of the terminal slope of the IgE concentration-time curve. The majority of the patients (n = 20) had experienced their initial clinical reaction within one year prior to measurement of the positive s-IgE, three within 5 years and 6 more than five years prior to blood sampling.
Data were analyzed for significance using the Fischer’s exact test.
Probability values of < 0.05 were considered statistically significant. The statistical analyses were performed with STATA 13, StataCorp, College Station, Texas, USA.
Generic Name: penicillin V (pen i SILL in)
Brand Names:PC Pen VK, Pen-V
Medically reviewed by Sanjai Sinha, MD Final updated on Dec 22, 2018.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time.
Do not take additional medicine to make up the missed dose.
Do not use this medication if you are allergic to penicillin V or to any other penicillin antibiotic, such as amoxicillin (Amoxil), ampicillin (Omnipen, Principen), carbenicillin (Geocillin), dicloxacillin (Dycill, Dynapen), or oxacillin (Bactocill).
Before using penicillin V, tell your doctor if you are allergic to cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others, or if you own asthma, kidney disease, a bleeding or blood clotting disorder, a history of diarrhea caused by taking antibiotics, or a history of any type of allergy.
Penicillin V can make birth control pills less effective, which may result in pregnancy.
Before taking this medicine, tell your doctor if you use birth control pills. Take penicillin V for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Penicillin V will not treat a viral infection such as the common freezing or flu. Do not give this medication to another person, even if they own the same symptoms you do.
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection.
If you own diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.
Before taking this medicine
Do not use this medication if you are allergic to penicillin V or to any other penicillin antibiotic, such as:
amoxicillin (Amoxil, Amoxicot, Biomox, Dispermox, Trimox);
dicloxacillin (Dycill, Dynapen); or
ampicillin (Omnipen, Principen);
Before using penicillin V, tell your doctor if you are allergic to any drugs (especially cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others), or if you have:
a history of diarrhea caused by taking antibiotics; or
a bleeding or blood clotting disorder;
a history of any type of allergy.
If you own any of these conditions, you may need a dose adjustment or special tests to safely take penicillin V.
FDA pregnancy category B.
Penicillin V is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Penicillin V can make birth control pills less effective, which may result in pregnancy. Before taking this medicine, tell your doctor if you use birth control pills. Penicillin V can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
What is penicillin?
Penicillin V is an antibiotic in the penicillin group of drugs. It fights bacteria in your body.
Penicillin V is used to treat numerous diverse types of infections caused by bacteria, such as ear infections,.
Penicillin V may also be used for other purposes not listed in this medication guide.
How should I take penicillin?
Take penicillin V exactly as it was prescribed for you.
Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
You may take penicillin V with or without food.
To be certain penicillin V is helping your condition, your blood may need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.
Shake the oral suspension (liquid) well just before you measure a dose.
To be certain you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not own a dose-measuring device, enquire your pharmacist for one.
Take penicillin V for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated.
Penicillin V will not treat a viral infection such as the common freezing or flu. Do not give this medicine to another person, even if they own the same symptoms you do.
Penicillin V can cause you to own unusual results with certain medical tests. Tell any doctor who treats you that you are using penicillin V.
Store penicillin V tablets at room temperature away from moisture, heat, and light. Store liquid penicillin V in a refrigerator but do not permit it to freeze. Throw away any liquid that has not been used within 14 days after it was mixed at the pharmacy.