The Hart and Louis Laboratory, Division of Clinical Immunology and Allergy, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095-1690, USA. erinalin @ mednet.ucla.edu
Int Arch Allergy Immunol. 2010;152(4):313-8. doi: 10.1159/000288284. Epub 2010 Feb 26.
Allergy to penicillins remains an important issue. Penicillin skin testing (PST) with major and minor determinants has been shown to be a highly valuable tool for identifying IgE-mediated penicillin allergy. The value of additional testing with side-chain-specific moieties from semisynthetic penicillins such as amoxicillin is not well-established in spite of the widespread use of these medications.
A retrospective review of all consecutive inpatient PST results from 1995 to 2007 comprising 1,068 patients was performed in our institution on individuals with a self-reported history of beta-lactam allergy to assess the importance of including the amoxicillin determinant in a previously validated PST panel. Descriptive statistics were performed. The PST panel included penicilloyl-polylysine, penicillin G, penicilloate, penilloate and amoxicillin.
Of 1,068 patients, 243 (23%) had a positive skin test reaction on the PST panel. Testing with amoxicillin was positive in 30.9% of patients, the majority of whom (81%) were also positive to 1 or more standard penicillin reagents. Fourteen of the 243 positive patients (5.8%) had a positive skin test reaction only to amoxicillin. Additionally, the use of penicilloate and penilloate minor determinants in combination with penicillin G identified a greater percentage of penicillin-allergic individuals compared to using only penicillin G (22.6 vs. 6.6%), demonstrating their importance in the PST panel.
These data indicate that the inclusion of the amoxicillin determinant appears to identify a small but important group of allergic individuals who may otherwise test negative on a PST panel.
青霉素过敏仍然是一个重要问题。青霉素皮试（PST）与主要和次要决定因素相结合，已被证明是识别 IgE 介导的青霉素过敏的非常有价值的工具。尽管这些药物广泛使用，但用半合成青霉素（如阿莫西林）的侧链特异性部分进行额外测试的价值尚未得到充分确立。
在我们机构对 1995 年至 2007 年期间所有连续住院患者的 PST 结果进行了回顾性分析，共 1068 例患者，这些患者自述有β-内酰胺类抗生素过敏史，以评估在以前验证过的 PST 面板中包含阿莫西林决定因素的重要性。进行了描述性统计分析。PST 面板包括青霉素酰多聚赖氨酸、青霉素 G、青霉素酸、苯氧甲基青霉素和阿莫西林。
在 1068 例患者中，有 243 例（23%）对 PST 面板的皮肤测试反应呈阳性。在 30.9%的患者中，阿莫西林检测呈阳性，其中大多数（81%）对 1 种或多种标准青霉素试剂也呈阳性。243 例阳性患者中有 14 例（5.8%）仅对阿莫西林呈阳性皮肤测试反应。此外，与仅使用青霉素 G 相比，使用苯氧甲基青霉素和苯氧甲基青霉素次要决定因素结合青霉素 G 可识别出更多的青霉素过敏个体（22.6%比 6.6%），表明它们在 PST 面板中的重要性。
这些数据表明，包含阿莫西林决定因素似乎可以识别一小部分但很重要的过敏个体，否则他们可能在 PST 面板上测试结果为阴性。
