ImmunoCAP Allergen c2, Penicilloyl V, is used for detection of IgE sensitization to the major allergenic determinant of penicillin V, with potential cross-reactivity to other penicillins.
Penicillin V (phenoxymethylpenicillin) is a natural antibiotic drug produced by industrial fermentation of Penicillium chrysogenum. Penicillins are small molecules and are not able to induce an immune response on their own. However, the β-lactam ring of penicillin is reactive and covalently binds to proteins, thereby forming hapten-carrier conjugates. Thus, penicillins react with primary amino groups in proteins to give penicilloyl amides, the major antigenic determinant of penicillin allergy (1), which is the allergen in ImmunoCAP Allergen c2, Peniclloyl V.
Drug therapy through oral administration is the main route of exposure to penicillin V. Minor routes of exposure are food consumption of animals treated with penicillin and inhalation of penicillin dust.
Extensive cross-reactivity exists between different penicillins. However, an increasing amount of evidence shows that side-chain specific reactions to especially amoxicillin have become more common (2). There are also occasional reports on specific reactions to penicillin V (3). Penicillins and cephalosporins cross-react to some extent, especially when the side-chains are identical (4).
The introduction of penicillin for treatment of bacterial infections in the 1940s was immediately followed by reports of allergic reactions. From a clinical view, penicillin allergic reactions can be classified as either immediate reactions occurring within one hour after the last penicillin administration, or as non-immediate reactions occurring at any time from 1 h to 48 h (5). Immediate reactions are usually IgE-mediated while non-immediate reactions are often induced by sensitized T cells. The longer the time before symptoms appear, the greater the possibility that a non-IgE mediated mechanism is involved. Immediate reactions are manifested clinically by urticaria, angioedema, rhinitis, bronchospasm and anaphylaxis. The main non-immediate reactions are maculopapular exanthema and delayed urticaria/angioedema.
The most comprehensive study on the performance of penicillin ImmunoCAP so far is the evaluation by Blanca and co-workers, who studied 129 patients in five groups. In the group with positive skin test to benzylpenicilloyl and amoxicillin, 68 % were positive to ImmunoCAP Allergen c1, Penicilloyl G (6).
- Levine BB, Price VH. Studies on the immunological mechanisms of penicillin allergy: II. Antigenic specificities of allergic wheal-and-flare skin responses in patients with histories of penicillin allergy. Immunology 1964; 36: 542-56.
- Blanca M, Mayorga C, Torres MJ, Warrington R, Romano A, Demoly P et al. Side chain specific reactions to betalactams: Twelve years later. Clin Exp Allergy 2002; 32: 192-7.
- Linares T, Marcos C, Gavilan M, Arenas L. Hypersensitivity to penicillin V with good tolerance to other β-lactams. J Investig Allergol Clin Immunol 2007; 17(1): 50-51.
- Antunez C, Blanca-Lopez N, Torres MJ, Mayorga C, Perez-Inestrosa, Montanez MI et al. Immediate allergic reactions to cephalosporins: Evaluation of cross-reactivity with a panel of penicillins and cephalosporins. J Allergy Clin Immunol 2006; 117(2): 404-10.
- Bousquet PJ, Kvedariene V, Co-Minh H-B, Martins P, Rongier M, Arnoux B et al. Clinical presentation and time course in hypersensitivity reactions to β-lactams. Allergy 2007; 62: 872-6.
- Blanca M, Mayorga C, Torres MJ, Reche M, Moya MC, Rodriguez JL et al. Clinical evaluation of Pharmacia CAP System RAST FEIA amoxicilloyl and benzylpenicilloyl in patients with penicillin allergy. Allergy 2001; 56: 862-70.