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Benzylpenicilloyl Polylysine

Pronunciation: BEN-zil-PEN-i-SIL-oh-il POL-ee-LYE-seen
Class: In vivo diagnostic aid

Trade Names

Pre-Pen
- Injection 6 × 10 −5 M per 0.25 mL

Pharmacology

Reacts specifically with benzylpenicilloyl immunoglobulin E (IgE) antibodies initiating the release of chemical mediators that produce an immediate wheal and flare reaction at a skin test site.

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Pharmacokinetics

Onset

Within 10 min (puncture test); within 5 to 15 min (intradermal test).

Indications and Usage

For the assessment of sensitization to penicillin (benzylpenicillin or penicillin G) in patients suspected to have clinical penicillin hypersensitivity.

Contraindications

Systemic or marked local reaction to prior benzylpenicilloyl polylysine administration; known extreme hypersensitivity to penicillin.

Dosage and Administration

Penicillin Hypersensitivity Skin Testing
Adults Step 1: Puncture technique

Apply a small drop of solution using a sterile 22- to 28-gauge needle and use the same needle to make a single shallow puncture of the epidermis through the drop of solution. As soon as a positive response is clearly evident, the solution over the scratch should be immediately wiped off. If the puncture test is negative or equivocally positive (less than 5 mm wheal with little or no erythema and no itching), an intradermal test (step 2) may be performed.

Step 2: Intradermal test

Inject an amount of solution sufficient to raise a small intradermal bleb of about 3 mm in diameter, in duplicate at least 2 cm apart. Using a separate syringe and needle, inject a similar amount of saline or allergen diluting solution as a control at least 5 cm removed from the antigen test sites.

General Advice

  • The skin test antigen should always be applied first by the puncture technique (step 1). If the puncture test is negative or equivocally positive, an intradermal test (step 2) may be performed.
  • Skin testing should be performed in an appropriate health care setting under direct medical supervision.
  • Skin testing is usually performed on the inner volar aspect of the forearm.
  • Skin testing responses can be attenuated by H 1 antihistamines and vasopressors. Skin testing should be delayed until the effects of such drugs have dissipated, or a separate skin test with histamine can be used to evaluate persistent antihistaminic effects in vivo.
  • Visually inspect for particulate matter and discoloration prior to administration.
  • Step 1: Puncture technique
  • After preparing the skin surface, apply a small drop of solution; the same needle (22- to 28-gauge) can then be used to make a single shallow puncture of the epidermis through the drop of solution. Observe for the appearance of a wheal, erythema, and the occurrence of itching at the test site during the succeeding 15 min, at which time the solution over the puncture site should be wiped off.
  • A positive reaction consists of the development within 10 min of a pale wheal, sometimes with pseudopods, surrounding the puncture site and varying in diameter from 5 to 15 mm (or more). This wheal may be surrounded by a variable diameter of erythema, and accompanied by a variable degree of itching. The most sensitive individuals develop itching quickly, and the wheal and erythema are prompt in their appearance. As soon as a positive response, as previously defined, is clearly evident, the solution over the scratch should be immediately wiped off. If the puncture test is negative or equivocally positive (less than 5 mm wheal with little or no erythema and no itching), an intradermal test may be performed.
  • Step 2: Intradermal test
  • Using a 0.5 to 1 cc syringe with a 3/ 8 - to 5/ 8 -inch long, 26- to 30-gauge, short bevel needle, withdraw the contents of the ampule. Prepare a skin test area on the upper outer arm with an alcohol swab, sufficiently below the deltoid muscle to permit proximal application of a tourniquet later, if necessary. Insert the needle bevel up immediately below the skin surface.
  • Most skin reactions will develop within 5 to 15 minutes and response to the skin test is read at 20 minutes as follows: negative response is no increase in size of original bleb and no greater reaction than the control site; ambiguous response is wheal only slightly larger than initial injection bleb, with or without accompanying erythematous flare and slightly larger than the control site or discordance between duplicates; positive response is itching, significant increase in size of original blebs to at least 5 mm, and wheal may exceed 20 mm in diameter and exhibit pseudopods. If the control site exhibits a wheal more than 2 to 3 mm, repeat the test; if the same reaction is observed, a health care provider experienced with allergy skin testing should be consulted.

Storage/Stability

Store at 36° to 46°F. Discard any unused portion. Solutions subjected to ambient temperatures for more than 24 h should be discarded.

Drug Interactions

None well documented.

Adverse Reactions

Dermatologic

Intense local inflammatory response at the skin test site.

Hypersensitivity

Systemic allergic reaction (eg, anaphylaxis, angioedema, dyspnea, generalized edema, hypotension, pruritus, urticaria).

Precautions

Pregnancy

Category C .

Lactation

No information available.

Children

The value of benzylpenicilloyl polylysine alone as a means of assessing the risk of administering penicillin is not established.

Hypersensitivity

Rarely, a systemic allergic reaction, including anaphylaxis, may follow a skin test.

Penicillin use

A serious allergic reaction to penicillin may occur in a patient with a negative skin test.

Patient Information

  • Instruct patients to inform their health care provider if they have a history of clinical penicillin hypersensitivity.
  • Advise patients to inform their health care provider if they are taking H 1 antihistamines or vasopressors.

Copyright © 2009 Wolters Kluwer Health.

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