Bousquet P J, Pipet A, Bousquet-Rouanet L, Demoly P
Exploration des Allergies, Maladies Respiratoires and INSERM, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier Cedex 5, France.
Clin Exp Allergy. 2008 Jan;38(1):185-90. doi: 10.1111/j.1365-2222.2007.02867.x. Epub 2007 Nov 1.
beta-lactams continue to remain the most commonly involved drug family in allergic drug reactions. They are often essential and there is a cost-effective and favourable risk-benefit ratio for the exploration of all suspicions of beta-lactam allergy. A firm diagnosis is always based on skin tests and sometimes on provocation tests. Recommendations have been published by allergy societies and distinguished scientists but they are not always concordant and can lead to some confusion for the practicing allergologist. The situation has even worsened since the world wide withdrawal of these penicillin determinants and since the predominance of amoxicillin and cephalosporin prescriptions in most countries. OBJECTIVE - METHOD: In a recent article, it was stated that patients with a penicillin allergy history and negative skin tests to major and minor penicillin determinants are at a low risk of relapse (0-5%) when receiving a beta-lactam. In this paper, our Drug Allergy and Hypersensitivity Database, a cohort database, was used to demonstrate that this statement is false. Standardized European Network for Drug Allergy questionnaires, skin test and challenge procedures were followed.
One-thousand two-hundred and eighteen subjects, 69.8% of female, 51.7% of atopics, were included. 21.1% had a true beta-lactam allergy confirmed by skin tests (178, 69.3%) or by drug provocation (79, 30.7%). 17.4% of the patients with negative skin tests to major and minor penicillin determinants were positive for a beta-lactam.
In the diagnosis of beta-lactams allergy, if all skin tests are negative, skin tests with other determinants and provocation tests under strict surveillance are mandatory.
β-内酰胺类药物仍然是药物过敏反应中最常涉及的药物类别。它们通常是必不可少的，对于所有β-内酰胺类药物过敏的怀疑进行排查具有成本效益且风险效益比良好。明确的诊断始终基于皮肤试验，有时还基于激发试验。过敏学会和杰出科学家已发布了相关建议，但它们并不总是一致的，可能会给执业过敏症专科医生带来一些困惑。自从这些青霉素决定簇在全球范围内停用，以及在大多数国家阿莫西林和头孢菌素处方占主导地位以来，这种情况甚至变得更糟。
目的 - 方法：在最近的一篇文章中指出，有青霉素过敏史且对主要和次要青霉素决定簇皮肤试验阴性的患者在接受β-内酰胺类药物时复发风险较低（0 - 5%）。在本文中，我们使用了药物过敏和超敏反应队列数据库来证明这一说法是错误的。遵循了标准化的欧洲药物过敏网络问卷、皮肤试验和激发程序。
纳入了1218名受试者，其中69.8%为女性，51.7%为特应性体质者。21.1%的患者经皮肤试验（178例，69.3%）或药物激发试验（79例，30.7%）确诊为真正的β-内酰胺类药物过敏。对主要和次要青霉素决定簇皮肤试验阴性的患者中有17.4%对β-内酰胺类药物呈阳性反应。
在β-内酰胺类药物过敏的诊断中，如果所有皮肤试验均为阴性，则必须进行其他决定簇的皮肤试验以及在严格监测下进行激发试验。
