Abstract

Introduction. The aim of this study was to compare the diagnostic value of two imunoglobulin E assays for penicillin in a group of patients with a history compatible with hypersensitivity reaction during penicillin treatment who exhibited positive skin testing and/or a drug provocation testing. Material and Methods. In the first part of the study, penicillin G, V and/or amoxicillin specific immunoglobulin E, positive with ImmunoCAP system (Termo Fisher, Waltham, Massachusetts, USA), were selected from our biobank sera, and measured specific immunoglobulin E with Immulite system (Siemens, Munich, Germany). The second part of the study included skin testing, and if negative, drug provocation testing was done with the culprit penicillin in patients with a history compatible with hyper?sensitivity reaction during penicillin treatment. To check the impact of high values of total immunoglobulin E on performance of specific immunoglobulin E, we examined the specific immunoglobulin E to penicillin using both methods in sera of penicillin tolerant patients with total immunoglobulin E over 700 kIU/L. Results. Out of 2.521 in vitro specific immunoglobulin E penicillin tests, 58 were positive with ImmunoCAP. Of these tests, 52 were tested by the Immulite and they were all negative. Among 114 patients with a history compatible with hypersensitivity reac?tion during penicillin treatment, hypersensitivity was confirmed in 36 (31.6%). In 11 patients with positive immediate skin or drug provocation tests, ImmunoCAP was positive in 3 patients and Immulite in 1 patient. Sensitivity of ImmunoCAP and Immulite were 27.1% and 9.1%, respec?tively. Specificity of ImmunoCAP and Immulite were 96.1% and 100%, respectively. Specific immunoglobulin E to penicillins was detected with ImmunoCAP in 8/22 sera with total immunoglobulin E over 700 kIU/L. All sera were negative by the Immulite. Conclusion. Both the Immuno?CAP and Immulite specific immunoglobulin E assays have low sensitiv?ity when assessing patients with a history of immediate hypersensitivity to penicillin, positive immediate skin, or drug provocation tests.

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