Salkind A R, Cuddy P G, Foxworth J W
University of Missouri-Kansas City School of Medicine, Green 4 Unit, 2411 Holmes St, Kansas City, MO 64108, USA.
JAMA. 2001 May 16;285(19):2498-505. doi: 10.1001/jama.285.19.2498.
Clinicians frequently withhold antibiotics that contain penicillin based on patients' self-reported clinical history of an adverse reaction to penicillin and the clinicians' own misunderstandings about the characteristics of a true penicillin allergy.
To determine the likelihood of true penicillin allergy with consideration of clinical history and to evaluate the diagnostic value added by appropriate skin testing.
MEDLINE was searched for relevant English-language articles dated 1966 to October 2000. Bibliographies were searched to identify additional articles.
We included original studies describing the precision of skin testing in diagnosis of penicillin allergy. We excluded studies that did not use both minor and major determinants, provide an explicit definition of penicillin allergy, or list the specific criteria necessary for a positive skin test result. Fourteen studies met the inclusion criteria.
Three authors independently reviewed and abstracted data from all articles and reached consensus about any discrepancies.
Patients' self-reported history has low accuracy for diagnosis of true penicillin allergy. By evaluating studies comparing clinical history to the skin test for penicillin allergy among patients with and without a positive history for penicillin allergy, positive and negative likelihood ratios were calculated. History of penicillin allergy had a positive likelihood ratio of 1.9 (95% confidence interval [CI], 1.5-2.5), while absence of history of penicillin allergy had a negative likelihood ratio of 0.5 (95% CI, 0.4-0.6).
Only 10% to 20% of patients reporting a history of penicillin allergy are truly allergic when assessed by skin testing. Taking a detailed history of a patient's reaction to penicillin may allow clinicians to exclude true penicillin allergy, allowing these patients to receive penicillin. Patients with a concerning history of type I penicillin allergy who have a compelling need for a drug containing penicillin should undergo skin testing. Virtually all patients with a negative skin test result can take penicillin without serious sequelae.
临床医生常常根据患者自述的青霉素不良反应病史以及自身对真正青霉素过敏特征的误解，停用含青霉素的抗生素。
结合临床病史确定真正青霉素过敏的可能性，并评估适当皮肤试验增加的诊断价值。
检索MEDLINE数据库中1966年至2000年10月的相关英文文章。检索参考文献以识别其他文章。
我们纳入了描述皮肤试验诊断青霉素过敏准确性的原始研究。我们排除了未使用次要和主要决定因素、未明确青霉素过敏定义或未列出皮肤试验阳性结果所需具体标准的研究。14项研究符合纳入标准。
三位作者独立审查并提取所有文章的数据，并就任何差异达成共识。
患者自述病史对诊断真正青霉素过敏的准确性较低。通过评估比较有和无青霉素过敏阳性病史患者的临床病史与青霉素过敏皮肤试验的研究，计算了阳性和阴性似然比。青霉素过敏史的阳性似然比为1.9（95%置信区间[CI]，1.5 - 2.5），而无青霉素过敏史的阴性似然比为0.5（95%CI，0.4 - 0.6）。
经皮肤试验评估，报告有青霉素过敏史的患者中只有10%至20%是真正过敏。详细了解患者对青霉素的反应病史可能使临床医生排除真正的青霉素过敏，从而使这些患者能够使用青霉素。有令人担忧的I型青霉素过敏病史且迫切需要使用含青霉素药物的患者应进行皮肤试验。几乎所有皮肤试验结果为阴性的患者都可以使用青霉素而不会有严重后遗症。
