Benzylpenicilloyl-polylysineU.S. Brand Names: Pre-Pen�(r)
Synonyms: Penicilloyl-polylysine; PPL
Generic Available: No
Use: Adjunct in assessing the risk of administering penicillin (penicillin or benzylpenicillin) in adults with a history of clinical penicillin hypersensitivity
Pregnancy Risk Factor: C
Pregnancy Implications: Safety for use during pregnancy has not been established.
Contraindications: Known hypersensitivity to penicillin or any component of the formulation
Warnings/Precautions: PPL test alone does not identify those patients who react to a minor antigenic determinant and does not appear to predict reliably the occurrence of late reactions. A negative skin test is associated with an incidence of allergic reactions <5% after penicillin administration and a positive skin test is associated with a >20% incidence of allergic reaction after penicillin administration; have epinephrine 1:1000 available.
Adverse Reactions: Frequency not defined. Cardiovascular: Hypotension Dermatologic: Angioneurotic edema, pruritus, erythema, urticaria Local: Intense local inflammatory response at skin test site, wheal (locally) Respiratory: Dyspnea Miscellaneous: Systemic allergic reactions occur rarely
Drug Interactions: Corticosteroids and other immunosuppressive agents may inhibit the immune response to the skin test
Stability: Refrigerate; discard if left at room temperature for longer than one day
Mechanism of Action: Elicits IgE antibodies which produce type I accelerate urticarial reactions to penicillins
Dosage: PPL is administered by a scratch technique or by intradermal injection. For initial testing, PPL should always be applied via the scratch technique. Do not administer intradermally to patients who have positive reactions to a scratch test. PPL test alone does not identify those patients who react to a minor antigenic determinant and does not appear to predict reliably the occurrence of late reactions. Scratch test: Use scratch technique with a 20-gauge needle to make 3-5 mm nonbleeding scratch on epidermis, apply a small drop of solution to scratch, rub in gently with applicator or toothpick. A positive reaction consists of a pale wheal surrounding the scratch site which develops within 10 minutes and ranges from 5-15 mm or more in diameter. Intradermal test: Use intradermal test with a tuberculin syringe with a 26- to 30-gauge short bevel needle; a dose of 0.01-0.02 mL is injected intradermally. A control of 0.9% sodium chloride should be injected at least 1.5" from the PPL test site. Most skin responses to the intradermal test will develop within 5-15 minutes. Interpretation: (-) Negative: No reaction (±) Ambiguous: Wheal only slightly larger than original bleb with or without erythematous flare and larger than control site (+) Positive: Itching and marked increase in size of original bleb Control site should be reactionless
Administration: PPL is administered by a scratch technique or by intradermal injection. For initial testing, PPL should always be applied via the scratch technique. Do not give intradermally to patients who have positive reactions to a scratch test. Have epinephrine 1:1000 immediately available.
Nursing Implications: Always use scratch test for initial testing; have epinephrine 1:1000 immediately available
Dental Health: Effects on Dental Treatment: No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions: No information available to require special precautions
Mental Health: Effects on Mental Status: None reported
Mental Health: Effects on Psychiatric Treatment: None reported
Dosage Forms: Injection, solution: 6 x 10-5 M (0.25 mL)
References: Boguniewicz M and Leung DYM, "Hypersensitivity Reactions to Antibiotics Commonly Used in Children,"Pediatr Infect Dis J, 1995, 14(3):221-31. Lin RY, "A Perspective on Penicillin Allergy,"Arch Intern Med, 1992, 152(5):930-7. Sogn DD, Evans R 3d, Shepherd GM, et al, "Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to Test the Predictive Value of Skin Testing with Major and Minor Penicillin Derivatives in Hospitalized Adults,"Arch Intern Med, 1992, 152(5):1025-32. Sullivan TJ, Wedner HJ, Schatz GS, et al, "Skin Testing to Detect Penicillin Allergy,"J Allergy Clin Immunol, 1981, 68:171-80. Weiss ME and Adkinson NF, "
-lactam Allergy" in Principles & Practice of Infectious Diseases, 3rd ed, Mandell GL, Douglas RG, Bennett, JE, 1990, Churchill Livingstone, 264-9. Wendel GD Jr, Stark BJ, Jamison RB, et al, "Penicillin Allergy and Desensitization in Serious Infections During Pregnancy,"N Engl J Med, 1985, 312(19):1229-32.
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