Geng Bob, Eastman Jacqueline J, Mori Karen, Braskett Melinda, Riedl Marc A
Division of Rheumatology, Allergy and Immunology, University of California-San Diego, La Jolla, California.
Division of Rheumatology, Allergy and Immunology, University of California-San Diego, La Jolla, California.
Ann Allergy Asthma Immunol. 2017 Sep;119(3):258-261. doi: 10.1016/j.anai.2017.06.009. Epub 2017 Jul 23.
Most patients with a history of penicillin allergy can tolerate penicillin. Skin testing can identify tolerant patients, but not all known allergenic determinants are commercially available. Protocols exist that use only available reagents, but the sensitivity and safety of these protocols, particularly for hospitalized patients, are controversial.
To determine the number of hospitalized patients referred for penicillin skin testing who showed unique positivity to the minor determinants penicilloate and penilloate.
A retrospective chart review was conducted of all inpatients who underwent penicillin skin testing at 1 institution. Patients were referred by their treating physician. All patients underwent skin prick testing to benzylpenicilloyl polylysine (major determinant), penicillin G, penicilloate, penilloate (minor determinants), amoxicillin, and positive and negative controls. If the result was negative, then intradermal testing was done with the same penicillin determinants and the negative control. A 4-mm wheal with flare was considered a positive reaction.
Inpatient penicillin skin testing was done in 528 subjects. Any positive test reaction was found in 107 subjects (20%). Three subjects (3%) reacted to penilloate only, 25 (23%) reacted to penicilloate only, 2 (2%) reacted to penicillin G only, and 8 (8%) reacted to amoxicillin only. Sixty-eight subjects (64%) reacted to a compound other than the major determinant.
This study found a high rate of exclusively positive skin test reactions to the minor determinants penicilloate and penilloate. Because patients with positive test reactions are at increased risk of reaction to drug challenge, these data support the use of these reagents for penicillin skin testing in hospitalized patients.
大多数有青霉素过敏史的患者能够耐受青霉素。皮肤试验可识别出耐受的患者，但并非所有已知的过敏原决定簇都有商业供应。存在仅使用现有试剂的方案，但其敏感性和安全性，尤其是对于住院患者而言，存在争议。
确定因青霉素皮肤试验而转诊的住院患者中，对次要决定簇青霉酸和青霉噻唑酸呈现独特阳性反应的患者数量。
对在1家机构接受青霉素皮肤试验的所有住院患者进行回顾性病历审查。患者由其主治医生转诊。所有患者均接受了对苄青霉素酰聚赖氨酸（主要决定簇）、青霉素G、青霉酸、青霉噻唑酸（次要决定簇）、阿莫西林以及阳性和阴性对照的皮肤点刺试验。如果结果为阴性，则用相同的青霉素决定簇和阴性对照进行皮内试验。风团直径达4毫米且伴有红晕被视为阳性反应。
528名受试者接受了住院青霉素皮肤试验。107名受试者（20%）出现了任何阳性试验反应。3名受试者（3%）仅对青霉噻唑酸有反应，25名（23%）仅对青霉酸有反应，2名（2%）仅对青霉素G有反应，8名（8%）仅对阿莫西林有反应。68名受试者（64%）对主要决定簇以外的化合物有反应。
本研究发现对次要决定簇青霉酸和青霉噻唑酸的皮肤试验反应呈单纯阳性的比例很高。由于试验反应呈阳性的患者药物激发试验反应的风险增加，这些数据支持在住院患者的青霉素皮肤试验中使用这些试剂。
