使用商业抗青霉素 IgE 荧光酶免疫分析法诊断青霉素过敏。
Use of commercial anti-penicillin IgE fluorometric enzyme immunoassays to diagnose penicillin allergy.
机构信息
Southern California Permanente Medical Group, Department of Allergy, San Diego Medical Center, San Diego, California, USA.
出版信息
Ann Allergy Asthma Immunol. 2010 Aug;105(2):136-41. doi: 10.1016/j.anai.2010.06.014.
BACKGROUND
The intermittent unavailability of penicilloyl-polylysine since September 2000 has focused interest on commercial anti-penicillin IgE fluorometric enzyme immunoassay (FEIA) tests to evaluate penicillin allergy. There has been no published comparison of commercial anti-penicillin IgE FEIAs and penicillin skin testing performed in the United States.
OBJECTIVE
To determine whether the current commercial anti-penicillin IgE FEIAs can replace or augment penicillin skin testing and oral challenges when evaluating individuals with a history of penicillin allergy for future therapeutic penicillin tolerance.
METHODS
A prospective convenience sample of 150 individuals with a history of penicillin allergy were evaluated between January 23, 2007, and August 4, 2009, with both penicillin skin tests and commercial anti-penicillin IgE FEIAs to penicillin G, penicillin V, and amoxicillin. All individuals with a negative penicillin skin test result underwent oral penicillin class antibiotic challenges. All individuals with a positive anti-penicillin IgE FEIA result also underwent oral penicillin class antibiotic challenges.
RESULTS
Six individuals (4.0%; 95% confidence interval [CI], 0.9% to 7.1%) had positive penicillin skin test results, and none had positive FEIA results. Four individuals (2.7%; 95% CI, 0.1% to 5.3%) had positive FEIA results, and none had positive penicillin skin test results. Three individuals (2.0%; 95% CI, -0.2% to 4.2%) had positive oral challenge results, 1 with hives at 6 hours after challenge and 2 with delayed-onset (at >24 hours) nonurticarial rashes, and none had positive FEIA results.
CONCLUSIONS
The current commercial anti-penicillin IgE FEIAs are not useful in diagnosing penicillin allergy in patients with remote histories of penicillin allergy. Penicillin skin testing and, if the results are negative, an oral challenge remain the criterion standard tests to determine therapeutic penicillin tolerance.
背景
自 2000 年 9 月以来，青霉素多聚赖氨酸间歇性无法获得，这引起了人们对商业性抗青霉素 IgE 荧光酶免疫分析（FEIA）检测的关注，以评估青霉素过敏。目前还没有发表过关于美国商业性抗青霉素 IgE FEIA 检测与青霉素皮试的比较。
目的
确定目前的商业性抗青霉素 IgE FEIA 检测是否可以替代或补充青霉素皮试和口服挑战，用于评估有青霉素过敏史的个体，以确定未来的治疗性青霉素耐受力。
方法
2007 年 1 月 23 日至 2009 年 8 月 4 日期间，对 150 名有青霉素过敏史的个体进行了前瞻性便利抽样，进行了青霉素 G、青霉素 V 和阿莫西林的青霉素皮试和商业性抗青霉素 IgE FEIA 检测。所有青霉素皮试阴性的个体均进行了口服青霉素类抗生素挑战。所有抗青霉素 IgE FEIA 检测阳性的个体也进行了口服青霉素类抗生素挑战。
结果
6 名个体（4.0%；95%置信区间[CI]，0.9%至 7.1%）的青霉素皮试结果阳性，而 FEIA 检测结果均为阴性。4 名个体（2.7%；95% CI，0.1%至 5.3%）的 FEIA 检测结果阳性，而青霉素皮试结果均为阴性。3 名个体（2.0%；95% CI，-0.2%至 4.2%）的口服挑战结果阳性，其中 1 名在挑战后 6 小时出现荨麻疹，2 名出现迟发性（>24 小时）非风团性皮疹，而 FEIA 检测结果均为阴性。
结论
目前的商业性抗青霉素 IgE FEIA 检测不适用于诊断有青霉素过敏史的患者的青霉素过敏。青霉素皮试和（如果结果为阴性）口服挑战仍然是确定治疗性青霉素耐受力的标准检测。
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