Arroliga M E, Wagner W, Bobek M B, Hoffman-Hogg L, Gordon S M, Arroliga A C
Section of Allergy and Immunology, The Cleveland Clinic Foundation, Cleveland Clinic Foundation, OH, USA.
Chest. 2000 Oct;118(4):1106-8. doi: 10.1378/chest.118.4.1106.
Penicillin skin testing is an accurate method to determine whether a person with a history of penicillin allergy is at risk of having an immediate reaction to penicillin. A patient with a negative reaction to a skin test may be able to use a penicillin compound safely, which could reduce the use of broad-spectrum antibiotics in this patient population.
We prospectively studied all patients with histories of penicillin allergy who were admitted to a medical ICU during a 3-month period and who received antibiotics. Skin testing was performed with benzylpenicilloyl polylysine and penicillin G. We determined the incidence of true allergy, the percentage of patients in whom antibiotic coverage was modified, and the safety of the test.
Two hundred fifty-seven patients were admitted to the medical ICU of The Cleveland Clinic Foundation during the study period. Twenty-four patients (9%), labeled as penicillin allergic and receiving antibiotics, were enrolled. Three patients (13%, 3 of 21) gave histories of type I reaction to penicillin and were not skin tested. Twenty patients (95%, 20 of 21) had negative skin test reactions to penicillin and positive skin test reactions to histamine control. One patient (4%, 1 of 21) with negative skin test reactions to both penicillin and histamine control had a test dose challenge with piperacillin that was well tolerated. There were no adverse events. Antibiotic coverage was changed in 10 patients (48%) as a result of skin testing.
Most patients with histories of allergy to penicillin have negative reactions to skin tests and may receive penicillin safely. Penicillin skin testing can be utilized as a safe and effective strategy to reduce the use of broad-spectrum antibiotics.
青霉素皮肤试验是一种准确的方法，用于确定有青霉素过敏史的人是否有对青霉素立即发生反应的风险。皮肤试验反应阴性的患者可能能够安全使用青霉素类药物，这可以减少该患者群体中广谱抗生素的使用。
我们前瞻性地研究了在3个月期间入住内科重症监护病房（ICU）并接受抗生素治疗的所有有青霉素过敏史的患者。用苄青霉素酰聚赖氨酸和青霉素G进行皮肤试验。我们确定了真正过敏的发生率、抗生素覆盖范围改变的患者百分比以及试验的安全性。
在研究期间，257名患者入住克利夫兰诊所基金会的内科ICU。24名被标记为青霉素过敏并接受抗生素治疗的患者被纳入研究。3名患者（21名中的3名，13%）有青霉素I型反应史，未进行皮肤试验。20名患者（21名中的20名，95%）对青霉素皮肤试验反应阴性，对组胺对照皮肤试验反应阳性。1名对青霉素和组胺对照皮肤试验反应均为阴性的患者（21名中的1名，4%）接受了哌拉西林试验剂量激发，耐受性良好。没有不良事件发生。由于皮肤试验，10名患者（48%）的抗生素覆盖范围发生了改变。
大多数有青霉素过敏史的患者皮肤试验反应阴性，可能可以安全地接受青霉素治疗。青霉素皮肤试验可作为一种安全有效的策略来减少广谱抗生素的使用。
