Evaluation of IR
Before ST, SIgE testing was carried out by fluoroimmunoassay (CAP
system, Thermofisher Diagnosis, Uppsala, Sweden R). Results of 0.35
kUA/l or more were considered positive11.
The determinants used for ST were penicilloyl-polylysine (PPL)
(5x10-5mol/l), minor determinant mixture
(2x10-2mol/l), and PG (104UI/ml). If
negative, we proceeded to the graded administration of penicillin V
until achieving the therapeutic dose5,19. If tolerated
well, we evaluated the response to AX if this drug was involved alone or
in combination with CLAV; if tolerance was still good, we proceeded to
ST with CLAV to test if this was the culprit, and then finally to a DPT
with AX-CLAV. If a cephalosporin was involved, we tested first with
common determinants of PG, and if negative, we proceeded to
cephalosporin (first ST and if negative, DPT when indicated).
DPT was performed in a single-blind, placebo-controlled way as described
elsewhere18, under strict hospital surveillance with
emergency room facilities. We gave escalating doses of the drug at
intervals of 30 min to 60 min until reaching the weight-adjusted
therapeutic dose5. BLs were administered orally at the
following doses: 5 mg, 25 mg, 50 mg, 75 mg, 100 mg, and 250 mg, with a
final observation period of at least 1 h after the last dose
administered.