Diagnosing penicillin allergy in the absence of minor determinant mixture
Bibliographic record
Abstract
Penicillin allergy is a common presentation in allergy clinic. The diagnosis of immediate hypersensitivity is made using clinical history, skin testing, specific IgE levels and oral challenge. Skin testing is done using benzyl penicilloyl-polylysine (PPL) and a minor determinant mixture (MDM) consisting of penicillin byproducts. Although using PPL and MDM is considered first line for diagnosis [ 1 ], our clinic is unable to consistently obtain MDM. We have undertaken a retrospective chart review to assess our current protocol in diagnosing penicillin allergy using Penicillin G (PG) alone instead of MDM. Charts of patients presenting to Allergy clinic with penicillin allergy between December 2005-Dec 2013 were reviewed. Skin testing by intradermal and skin prick testing was done using PPL and MDM or PG in addition to other possible suspected antibiotics. Patients who were negative for specific IgE testing to penicillin V and G (Immunocap) and had negative skin tests had oral challenge to penicillin. Of 520 charts reviewed, 240 patients met criteria for analysis. 18 out of 240 patients had positive skin testing, eight to PPL, five to PG, four to MDM, six to ampicillin and one to ceftriaxone. Three patients had positive specific IgE levels with negative skin tests to PPL and PG. 222 patients underwent challenge. 88/222 had been skin tested to MDM and 8/88 had a positive challenge. 134/222 had been skin tested to PG and 4/134 had a positive challenge. 9% of patients with positive oral challenge had negative testing with MDM compared to 3% with PG. Therefore we conclude that our current protocol is appropriate in diagnosing patients with penicillin allergy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".