Marwood Joseph, Aguirrebarrena Gonzalo, Kerr Stephen, Welch Susan A, Rimmer Janet
Department of Emergency Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.
The Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia.
Emerg Med Australas. 2017 Oct;29(5):509-515. doi: 10.1111/1742-6723.12774. Epub 2017 Apr 5.
Self-reported penicillin allergy is common among patients attending the ED, but is a poor predictor of true immunoglobulin E-mediated hypersensitivity to penicillin. We hypothesise that with a combination of skin testing and drug provocation testing, selected patients can be safely de-labelled of their allergy.
This prospective study enrolled a sample of patients presenting to an urban academic ED between 2011 and 2016 with a self-reported allergy to penicillin. Standardised skin prick and intradermal testing with amoxicillin and both major and minor determinants of penicillin was performed in the department. If negative, testing was followed by a graded oral challenge of amoxicillin over 9 days. The primary end point was the allergy status of participants at the end of the study.
A total of 100 patients (mean age 42; standard deviation 14 years; 54% women) completed the testing. Of these, 81% (95% confidence interval 71.9-88.2) showed no hypersensitivity to penicillin and were labelled non-allergic. The majority (16/19) of allergies were confirmed by skin testing, with three suspected allergies detected by the oral challenge. Women were more likely than men to have a true penicillin allergy, with odds ratio of 4.0 (95% confidence interval 1.23-13.2). There were no serious adverse events.
Selected patients in the ED who self-report an allergy to penicillin can be safely tested there for penicillin allergy, using skin tests and oral drug provocation testing. This testing allows a significant de-labelling of penicillin allergy, with the majority of these patients able to tolerate penicillin without incident.
在急诊科就诊的患者中，自述青霉素过敏很常见，但这并不能很好地预测真正由免疫球蛋白E介导的对青霉素的超敏反应。我们假设，通过皮肤试验和药物激发试验相结合，部分患者可以安全地去除其过敏标签。
这项前瞻性研究纳入了2011年至2016年间到一所城市学术性急诊科就诊且自述对青霉素过敏的患者样本。在科室进行了用阿莫西林以及青霉素的主要和次要决定簇进行的标准化皮肤点刺试验和皮内试验。如果结果为阴性，则在接下来的9天内对阿莫西林进行分级口服激发试验。主要终点是研究结束时参与者的过敏状态。
共有100名患者（平均年龄42岁；标准差14岁；54%为女性）完成了测试。其中，81%（95%置信区间71.9 - 88.2）对青霉素无超敏反应，被标记为非过敏。大多数（16/19）过敏通过皮肤试验得到证实，口服激发试验检测出3例疑似过敏。女性比男性更有可能对青霉素有真正的过敏，比值比为4.0（95%置信区间1.23 - 13.2）。没有严重不良事件发生。
在急诊科自述对青霉素过敏的部分患者，可以在那里使用皮肤试验和口服药物激发试验对青霉素过敏进行安全检测。这种检测能显著去除青霉素过敏标签，这些患者中的大多数能够耐受青霉素且无不良反应。
