Simpson Alyson B, Murphy Andrew W, Yousef Ejaz
Division of Allergy and Immunology, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, Delaware, USA.
Allergy Asthma Proc. 2009 Mar-Apr;30(2):192-201. doi: 10.2500/aap.2009.30.3210.
Currently, there is no standard protocol to test for penicillin (PCN) allergy since PrePen (manufactured benzylpenicilloyl polylysine; AllerQuest, West Hartford, CT) was discontinued in 2004. Our article reviews allergist's opinions on a protocol to test for PCN allergy in patients without a history of a life-threatening reaction. This study was performed to determine whether fellows of the American Academy of Allergy, Asthma, and Immunology (AAAAI) would use a two-challenge PCN allergy protocol to test for PCN allergy while skin testing to the major determinant, benzylpenicilloyl polylysine, is unavailable. A questionnaire regarding PCN allergy and application of a four-step protocol was sent to 1210 allergists and immunologists. Of the 654 respondents, 324 (49.5%) believed that the protocol was practical in a busy, outpatient allergy practice and 64 (9.8%) wanted more information. One hundred ninety-four (29.7%) did not think it was practical. Two hundred ninety-five respondents (45.1%) then went on to respond that they would apply the protocol in an outpatient practice and 117 (17.9%) were undecided and wanted more information. One hundred thirty-five respondents (20.6%) would not apply the protocol in their practice. Of those who were undecided or did not think it was practical, 58 (8.9%) were awaiting PrePen, 33 (5%) wanted to see a larger protocol, 24 (3.7%) wanted more detail on the challenge, and 14 (2.1%) felt more comfortable desensitizing the patient. Forty-five percent of the fellows of the AAAAI would apply the proposed protocol to test for PCN allergy. Sixty-two percent said they may apply the protocol if a larger study was performed.
由于预填充青霉素（PrePen，生产的苄青霉素酰聚赖氨酸；AllerQuest，美国康涅狄格州西哈特福德）于2004年停产，目前尚无检测青霉素（PCN）过敏的标准方案。我们的文章回顾了过敏症专科医生对于在无危及生命反应病史患者中检测PCN过敏方案的看法。本研究旨在确定美国过敏、哮喘与免疫学会（AAAAI）的成员在无法进行针对主要决定簇苄青霉素酰聚赖氨酸的皮肤试验时，是否会采用两步挑战PCN过敏方案来检测PCN过敏。一份关于PCN过敏及四步方案应用的问卷被发送给了1210名过敏症专科医生和免疫学家。在654名受访者中，324人（49.5%）认为该方案在繁忙的门诊过敏诊疗中切实可行，64人（9.8%）希望获取更多信息。194人（29.7%）认为该方案不切实可行。随后，295名受访者（45.1%）表示他们会在门诊诊疗中应用该方案，117人（17.9%）未作决定并希望获取更多信息。135名受访者（20.6%）不会在他们的诊疗中应用该方案。在未作决定或认为该方案不切实可行的人中，58人（8.9%）在等待PrePen，33人（5%）希望看到更大规模的方案，24人（3.7%）希望获取关于挑战的更多细节，14人（2.1%）觉得对患者进行脱敏会更安心。AAAAI的成员中有45%会应用提议的方案来检测PCN过敏。62%的人表示如果进行更大规模的研究，他们可能会应用该方案。
