Uno K, Yamasaku F
Department of Internal Medicine, Suibarago Hospital, Niigata, Japan.
J Antimicrob Chemother. 1989 Aug;24(2):241-50. doi: 10.1093/jac/24.2.241.
In 90 suspected cases of beta-lactam hypersensitivity manifesting exanthema, pyrexia and hepatopathic symptoms, the identities of the allergenic drugs were investigated by immediate type skin reactions, sensitized erythrocyte agglutination tests and leucocyte migration inhibition tests (LMIT). In addition 30 control patients were tested for hypersensitivity to ampicillin, cephalexin and latamoxef. The control patients manifested the same symptoms as the patients with suspected hypersensitivity to beta-lactam but had not been treated with beta-lactam antibiotics. In the immediate type skin reaction, all the control cases as well as all the suspected beta-lactam hypersensitive patients displayed negative reactions to each of the antibiotics tested. In the sensitized erythrocyte agglutination tests, no antibodies to any of the three drugs were detected in the control group, while antibodies with a titre of 1:2 or more were detected in only 7% (6/90) of the suspected beta-lactam hypersensitive patients. On the other hand, in the LMIT, only 4% (4/90) of the control patients displayed positive reactions to the three test antibiotics, whereas the suspected sensitizing drugs elicited a high rate of positive responses (68/90; 76%) in the group of suspected beta-lactam hypersensitive patients. Broken down into symptomatic categories, response to the LMIT was positive in 41 of 58 cases of suspected drug rash (71%), 26 of 26 cases of suspected drug fever (96%), and 20 of 24 cases of suspected drug-induced hepatopathy (83%). Thus, the pyrexial group exhibited a particularly high ratio of positive reactions, and in fact exanthemic cases with concomitant symptoms (eosinophilia, pyrexia, hepatopathy, etc.) also displayed a notably high ratio of positives (19/20; 95%). The overall results indicated that delayed type hypersensitivity (DTH) is largely involved in exanthema, pyrexia and hepatopathy induced by beta-lactam antibiotics, and that the LMIT constitutes an effective means of detecting allergenic drugs in patients with beta-lactam hypersensitivity.
在90例疑似β-内酰胺类药物超敏反应且表现为皮疹、发热及肝病症状的病例中，通过速发型皮肤反应、致敏红细胞凝集试验和白细胞游走抑制试验（LMIT）来调查致敏药物的种类。此外，对30例对照患者进行了氨苄西林、头孢氨苄和拉氧头孢的超敏反应检测。对照患者表现出与疑似β-内酰胺类药物超敏反应患者相同的症状，但未接受过β-内酰胺类抗生素治疗。在速发型皮肤反应中，所有对照病例以及所有疑似β-内酰胺类药物超敏反应患者对所检测的每种抗生素均呈阴性反应。在致敏红细胞凝集试验中，对照组未检测到针对这三种药物中任何一种的抗体，而在疑似β-内酰胺类药物超敏反应患者中，仅7%（6/90）检测到滴度为1:2或更高的抗体。另一方面，在LMIT中，仅4%（4/90）的对照患者对三种测试抗生素呈阳性反应，而在疑似β-内酰胺类药物超敏反应患者组中，疑似致敏药物引发了较高的阳性反应率（68/90；76%）。按症状类别细分，58例疑似药物疹病例中有41例（71%）对LMIT反应呈阳性，26例疑似药物热病例中有26例（96%）呈阳性，24例疑似药物性肝病病例中有20例（83%）呈阳性。因此，发热组的阳性反应率特别高，事实上伴有症状（嗜酸性粒细胞增多、发热、肝病等）的皮疹病例也显示出较高的阳性率（19/20；95%）。总体结果表明，迟发型超敏反应（DTH）在很大程度上参与了β-内酰胺类抗生素引起的皮疹、发热和肝病，并且LMIT是检测β-内酰胺类药物超敏反应患者致敏药物的有效方法。
