Jost Barbara Capes, Wedner H James, Bloomberg Gordon R
Division of Allergy and Immunology, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Ann Allergy Asthma Immunol. 2006 Dec;97(6):807-12. doi: 10.1016/S1081-1206(10)60973-8.
Adverse reactions associated with penicillin-type antibiotics are common in pediatric practice, leading to the subsequent unnecessary use of alternative antibiotics. IgE-mediated penicillin allergy represents only a fraction of these adverse reactions.
To examine (1) the trend of penicillin skin test reactivity during a recent 10-year interval, (2) the relative distribution of specific reagents related to a positive skin test result, and (3) skin test reactivity as a function of reaction history.
Penicillin testing using 3 reagents--benzylpenicilloyl polylysine, penicillin G, and sodium penicilloate (penicillin A)--was conducted in a prospective study of 359 consecutive patients referred to an outpatient pediatric allergy clinic between January 1, 1993, and May 31, 2003. We also retrospectively reviewed penicillin skin test results for 562 children previously tested between January 1, 1979, and December 31, 1992.
Between 1993 and 2003, the prevalence of penicillin skin test sensitivity markedly declined. Of all the positive skin test results between 1979 and 2002, either penicillin G or sodium penicilloate or both identified 34%, with sodium penicilloate alone responsible for 8.5%. The rate of positive skin test reactions was not significantly different between patients with vs without a history of suggestive IgE-mediated reactions.
A marked decline in penicillin skin test sensitivity in the pediatric age group is identified. The minor determinant reagents penicillin G and sodium penicilloate are both necessary for determining potential penicillin allergy. Relating history alone to potential penicillin sensitivity is unreliable in predicting the presence or absence of a positive skin test result.
在儿科临床实践中，与青霉素类抗生素相关的不良反应很常见，这导致随后不必要地使用替代抗生素。IgE介导的青霉素过敏仅占这些不良反应的一小部分。
研究（1）最近10年间青霉素皮肤试验反应性的趋势，（2）与皮肤试验阳性结果相关的特定试剂的相对分布，以及（3）作为反应史函数的皮肤试验反应性。
在1993年1月1日至2003年5月31日期间，对连续转诊至一家儿科门诊过敏诊所的359例患者进行了前瞻性研究，使用3种试剂——苄青霉素酰聚赖氨酸、青霉素G和青霉酸钠（青霉素A）进行青霉素检测。我们还回顾性分析了1979年1月1日至1992年12月31日期间先前检测的562名儿童的青霉素皮肤试验结果。
1993年至2003年期间，青霉素皮肤试验敏感性的患病率显著下降。在1979年至2002年期间所有皮肤试验阳性结果中，青霉素G或青霉酸钠或两者同时检测出的占34%，仅青霉酸钠检测出的占8.5%。有或无提示性IgE介导反应史的患者之间皮肤试验阳性反应率无显著差异。
确定儿科年龄组中青霉素皮肤试验敏感性显著下降。次要决定簇试剂青霉素G和青霉酸钠对于确定潜在的青霉素过敏都是必要的。仅根据病史来判断潜在的青霉素敏感性在预测皮肤试验结果阳性与否方面并不可靠。
