A case of persistent IgE sensitisation almost two decades following ampicillin anaphylaxis

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Elaine YL Au https://orcid.org/0000-0003-2724-6425
Valerie Chiang
Andy Ka Chun Kan https://orcid.org/0000-0002-1943-2562
Ki Lam
Jane CY Wong
Heather HY Yeung
Philip Hei Li https://orcid.org/0000-0002-9155-9162


allergy, anaphylaxis, basophil activation test, penicillins, specific IgE


Background: Although most immunoglobulin E (IgE)-mediated penicillin allergy wanes with time, sensitisation may occasionally persist for many years. Previous reports on the loss of penicillin-specific IgE sensitisation were based on non-anaphylaxis cases and, although uncommon, persistent sensitisation may still be possible in the minority of cases.

Objective: This case highlights that irrespective of the elapsed duration since the index reaction, it is important to remain vigilant when approaching patients with a history of severe reactions.

Material and Methods: We described a case of persistent IgE sensitisation almost two decades following ampicillin anaphylaxis.

Results: A 78-year-old male with a history of perioperative penicillin anaphylaxis in 2003 was referred for allergy workup in 2022 before his knee joint replacement surgery. The patient had strictly avoided all beta-lactams since the index reaction. However, his penicillin-specific sensitisation persisted, evidenced by positive skin tests (with generalised urticaria after intradermal testing) and basophil activation tests.

Conclusion: To our knowledge, this was the first case of positive BAT tested around two decades following the index reaction. This case illustrates that a cautious approach may still be warranted in patients with a history of severe reaction to penicillin regardless of the duration since the reported index reaction.

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