Penicillins allergy clinical manifestations

In one case of tubulointerstitial nephritis and nephrotic syndrome induced by Triazolam, a sleep inducer numerous eosinophils [85] were found to infiltrate glomeruli and interstitium suggesting that eosinophils may be pathogenic in this situation. An association with tubulointerstitial nephritis and nephrotic syndrome has also been occasionally reported for penicillin/ amoxicillin induced nephropathies [86]. Several reports have analyzed T-cells in penicillin-induced allergy. CD4 T-cells specific for penicillin may be derived from the patients and produce mainly lL-5, some of them being perforin positive with a cytolytic potential [87]. 2) P-lactam specific clones may be obtained only from patients with adverse reactions the clones were Th2 whatever the type of clinical manifestations and... 

Lack of previous exposure is not the same as lack of history of previous exposure, and first dose reactions are among the most dramatic. Exposure is not necessarily medical, e.g. penicillins may occur in dairy products following treatment of mastitis in cows (despite laws to prevent this), and penicillin antibodies are commonly present in those who deny ever having received the drug. Immune responses to drugs may be harmful (allergy) or harmless the fact that antibodies are produced does not mean a patient will necessarily respond to re-exposure with dinical manifestations most of the UK population has antibodies to penicillins but, fortunately, comparatively few react clinically to penicillin administration. 

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