对苄青霉素、阿莫西林和氨苄西林不同决定簇的免疫反应。荨麻疹与过敏性休克的比较。

Immunologic response to different determinants of benzylpenicillin, amoxicillin, and ampicillin. Comparison between urticaria and anaphylactic shock.

作者信息

Torres M J, Mayorga C, Pamies R, Rodriquez J L, Juarez C, Romano A, Blanca M

机构信息

Internal Medicine Department, Carlos-Haya Hospital, Málaga, Spain.

出版信息

Allergy. 1999 Sep;54(9):936-43. doi: 10.1034/j.1398-9995.1999.00175.x.

DOI:10.1034/j.1398-9995.1999.00175.x

PMID:10505456

Abstract

BACKGROUND

Subjects with IgE-mediated allergic reactions to penicillins can develop urticaria or anaphylactic shock. Urticaria is mainly associated with positivity to the major determinant of benzylpenicillin (BPO), and anaphylactic shock with minor determinants (MDM). The presence of IgG antibodies to BPO is thought to be mainly associated with urticaria, possibly protecting from anaphylactic shock. We aimed to study the skin test response to BPO and MDM, amoxicillin (AX), and ampicillin (AMP) in a group of subjects allergic to penicillins, and to evaluate the role of specific IgG.

METHODS

We studied a group of patients with immediate allergic reactions to penicillins, comparing urticaria and anaphylactic shock. Skin tests were done with BPO, MDM, AX, and AMP. Specific IgE and IgG antibodies to benzylpenicilloyl-poly-L-lysine (BPO-PLL) and amoxicilloyl-poly-L-lysine (AXO-PLL) were determined by RAST and ELISA, respectively.

RESULTS

Fifty-nine patients were studied (30 with anaphylactic shock and 29 with urticaria). Skin test positivity to BPO was associated with urticaria (P<0.001), and positivity to MDM, AX, and AMP with anaphylactic shock (P=0.006, P<0.001, and P=0.002, respectively). Specific anti-BPO-PLL and AXO-PLL IgG values were higher in patients than controls (P<0.001), but no differences were observed between urticaria and anaphylactic shock.

CONCLUSIONS

Positivity to minor determinants of penicillins is associated more with anaphylactic shock than urticaria, but the role of IgG antibodies in helping to prevent the development of anaphylactic shock could not be confirmed.

摘要

背景

对青霉素发生IgE介导的过敏反应的受试者可能会出现荨麻疹或过敏性休克。荨麻疹主要与对苄青霉素（BPO）主要决定簇呈阳性有关，而过敏性休克与次要决定簇（MDM）有关。针对BPO的IgG抗体的存在被认为主要与荨麻疹有关，可能会预防过敏性休克。我们旨在研究一组对青霉素过敏的受试者对BPO和MDM、阿莫西林（AX）及氨苄西林（AMP）的皮肤试验反应，并评估特异性IgG的作用。

方法

我们研究了一组对青霉素有速发型过敏反应的患者，比较了荨麻疹患者和过敏性休克患者。用BPO、MDM、AX和AMP进行皮肤试验。分别通过放射性变应原吸附试验（RAST）和酶联免疫吸附测定（ELISA）测定针对苄青霉素酰聚-L-赖氨酸（BPO-PLL）和阿莫西林酰聚-L-赖氨酸（AXO-PLL）的特异性IgE和IgG抗体。

结果

共研究了59例患者（30例过敏性休克患者和29例荨麻疹患者）。对BPO皮肤试验呈阳性与荨麻疹相关（P<0.001），而对MDM、AX和AMP呈阳性与过敏性休克相关（分别为P=0.006、P<0.001和P=0.002）。患者体内特异性抗BPO-PLL和AXO-PLL IgG值高于对照组（P<0.001），但荨麻疹患者和过敏性休克患者之间未观察到差异。