Confino-Cohen Ronit, Rosman Yossi, Meir-Shafrir Keren, Stauber Tali, Lachover-Roth Idit, Hershko Alon, Goldberg Arnon
Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Allergy Clin Immunol Pract. 2017 May-Jun;5(3):669-675. doi: 10.1016/j.jaip.2017.02.023.
Penicillins are the drug family most commonly associated with hypersensitivity reactions. Current guidelines recommend negative skin tests (ST) before re-administering penicillins to patients with previous nonimmediate reactions (NIR).
The objective of this study was to examine whether ST are necessary before re-administering penicillin to patients with NIR.
Patients with NIR to penicillins starting longer than 1 hour after last dose administration or starting any time after the first treatment day or patients with vague recollection of their reaction underwent penicillin ST. Disregarding ST results, patients were challenged with the relevant penicillins. One-tenth of the therapeutic dose followed by the full dose was administered at 1-hour interval and patients continued taking the full dose for 5 days.
A total of 710 patients with alleged BL allergy were evaluated. Patients with a history of immediate reaction (52, 7.3%) or cephalosporin allergy (16, 2.2%) were excluded. Of the remaining 642 patients, 62.3% had negative ST, 5.3% positive ST, and 32.4% equivocal ST. A total of 617 (96.1%) patients were challenged. Immediate reaction was observed in 9 patients (1.5%): 1-positive ST, 7-negative ST, and 1-equivocal ST (P = .7). Late reaction to the first-day challenge occurred in 24 patients (4%). An at-home challenge was continued by 491 patients. Complete 5-day and partial challenges were well tolerated by 417 (85%) and 44 patients (8.9%), respectively, disregarding ST results. Thirty patients (6.1%) developed mild reactions to the home challenge regardless of their ST results.
A 5-day oral challenge without preceding ST is safe and sufficient to exclude penicillin allergy after NIR developing during penicillin treatment.
青霉素是最常与超敏反应相关的药物类别。当前指南建议，对于既往有非速发型反应（NIR）的患者，在重新使用青霉素之前应进行皮肤试验（ST）阴性。
本研究的目的是探讨对于有NIR的患者，重新使用青霉素之前是否有必要进行ST。
对末次给药后1小时以上开始出现NIR、首次治疗日后任何时间开始出现NIR的青霉素患者，或对反应记忆模糊的患者进行青霉素ST。不顾ST结果，让患者接受相关青霉素激发试验。以治疗剂量的十分之一开始，之后按1小时间隔给予全剂量，患者持续服用全剂量5天。
共评估了710例疑似青霉素过敏患者。有速发型反应史（52例，7.3%）或头孢菌素过敏史（16例，2.2%）的患者被排除。其余642例患者中，62.3%的ST结果为阴性，5.3%为阳性，32.4%为可疑。共有617例（96.1%）患者接受了激发试验。9例患者（1.5%）出现速发型反应：1例ST阳性，7例ST阴性，1例ST可疑（P = 0.7）。首日激发试验出现迟发型反应的有24例患者（4%）。491例患者继续进行家庭激发试验。无论ST结果如何，417例（85%）完成5天全程激发试验和44例（8.9%）部分激发试验的患者耐受性良好。30例患者（6.1%）无论ST结果如何，对家庭激发试验均出现轻度反应。
对于青霉素治疗期间发生NIR后，在不进行预先ST的情况下进行5天口服激发试验，对于排除青霉素过敏是安全且充分的。
