Department of Dermatology and Allergy Centre, Odense University Hospital, Odense C, Denmark.
Allergy. 2013 Aug;68(8):1057-64. doi: 10.1111/all.12195. Epub 2013 Jul 29.
Skin testing in duplicate, correlation between case history of immediate and nonimmediate reactions and challenge outcome and prolonged oral treatment with penicillin in the diagnostic evaluation of allergic reactions to β-lactam antibiotics, mimicking real-life situations, have only been addressed in few studies.
A total of 342 patients suspected of having β-lactam allergy were investigated according to the European Network for Drug Allergy (ENDA) guidelines and patients found to be negative in the ENDA program were supplemented with a 7-day oral treatment with penicillin. Skin testing with penicillins was performed in duplicate. Patients with case histories of reactions to other β-lactams were also subsequently challenged with the culprit drug.
Nineteen patients were IgE-sensitized to penicillin. Then, intracutaneous tests (ICTs) were performed, in which 35 patients tested positive for allergy, 21 with delayed and 14 with immediate reactions. Only three patients tested positive for the major (PPL) and/or minor (MDM) penicillin determinants, all being positive for penicillin G in ICT. The remaining 291 patients were challenged with penicillin: 10 tested positive in single-dose challenge and 23 tested positive in the 7-day challenge. A total of 17 of 78 patients with a negative penicillin challenge tested positive during challenges with other β-lactams. We found no correlation between case histories of immediate and nonimmediate reactions and reaction time during challenge.
The data suggest that case history is often insufficient to discriminate between immediate reactors and nonimmediate reactors. A 7-day challenge with the culprit β-lactam may yield more positive reactions than the accepted one- or 2-day challenge. Interpretation of skin testing should be made with caution.
在重复皮肤测试、病例史中即刻和非即刻反应与挑战结果的相关性，以及在β-内酰胺类抗生素过敏反应的诊断评估中，口服青霉素治疗时间延长（模拟实际情况）方面，仅有少数研究涉及。
根据欧洲药物过敏网络（ENDA）指南，对 342 例疑似β-内酰胺类过敏的患者进行了调查，在 ENDA 方案中发现为阴性的患者，补充了 7 天的青霉素口服治疗。对青霉素进行重复皮肤测试。有其他β-内酰胺类药物反应病史的患者随后也接受了致敏药物的挑战。
19 例患者对青霉素呈 IgE 敏感。随后进行了皮内试验（ICT），其中 35 例对过敏测试阳性，21 例为迟发型，14 例为即刻型。只有 3 例患者对主要（PPL）和/或次要（MDM）青霉素决定簇呈阳性，所有患者在 ICT 中对青霉素 G 均呈阳性。其余 291 例患者接受了青霉素挑战：10 例在单剂量挑战中呈阳性，23 例在 7 天挑战中呈阳性。在 78 例青霉素挑战阴性的患者中，共有 17 例在接受其他β-内酰胺类药物挑战时呈阳性。我们发现即刻和非即刻反应的病例史与挑战期间的反应时间之间没有相关性。
数据表明，病例史往往不足以区分即刻反应者和非即刻反应者。与公认的 1 天或 2 天挑战相比，用致敏β-内酰胺类药物进行 7 天挑战可能会产生更多的阳性反应。皮肤测试的解释应谨慎进行。
