Nonirritating Skin Test Concentrations

EAACI Position Paper 2013

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Practice Parameter (2010)

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Non-Beta-Lactam Antibiotics (Romano)

  • Quinolones - low sensitivity but better specificity, positive skin test suggests higher risk for a positive challenge
    • Levofloxacin - SPT up to 5 mg/mL, ID up to 0.05 mg/mL
    • Ciprofloxacin - SPT up to 2 mg/mL, ID up to 0.006 mg/mL
    • Moxifloxacin - SPT up to 5 mg/mL, ID up to 0.004 mg/mL
  • Macrolides
    • Macrolides are classified according to the number of carbon atoms in their lactone ring: 14 membered (erythromycin, troleandomycin, roxithromycin, dirithromycin, and clarithromycin), 15 membered (azithromycin), and 16 membered (spiramycin, rokitamycin, josamycin, and midecamycin)
    • Low sensitivity but better specificity, positive skin test suggests higher risk for a positive challenge
    • Skin test concentrations as per practice parameter
    • Macrolide hypersensitivity is unlikely to be a class hypersensitivity
  • Aminoglycosides
    • Classified into 2 groups: the streptidine group (e.g., streptomycin) and the desoxystreptamine group (e.g., kanamycin, amikacin, gentamicin, tobramycin, and neomycin)
    • Cross-reactivity among aminoglycosides is common, approaching 50% or more among those that belong to the desoxystreptamine group, with no cross-reactivity noted between the streptidine and desoxystreptamine group


References