A special case of penicillin allergy: anaphylactic immediate reaction and booster response by means of skin testing

In December 1997, a 37-year-old patient with a blank medication history had anaphylactic immediate reactions after taking of one tablet penicillin V ( phenoxy methyl penicillin): generalized itching and urticarial rash, angion eurotic oedemas, vomiting, dyspnoea as well as circulatory collapse. An eme rgency treatment in a hospital was necessary. In April 1998 and June 1998, at first serological examinations with the CAP IgE FEIA were arranged as a proof of specific antibodies to penicillin G and V to clarify the anaphylac tic reactions. Due to negative results, skill tests with a penicillin serie s were carried out with the inclusion of benzylpenicilloyl-polylysine (PPL) and the minor determinant mixture (MDM). Intradermal tests were carried ou t after a negative prick test. There was an intense reaction with reddening and urtication starting from the test site benzylpenicillin G which extend ed over the arm and trunk followed by nausea and vomiting; an immediate eme rgency treatment was initiated. Six weeks after the skin testing, specific IgE-antibodies to penicillin G (class 2) and penicillin V (class 1) could b e verified then. Therefore a booster response took place by means of the sk in tests.