Division of Allergy & Clinical Immunology, Johns Hopkins Asthma & Allergy Center, Baltimore, Maryland; AllerQuest LLC, Plainville, Connecticut.
AllerQuest LLC, Plainville, Connecticut; University of Connecticut School of Medicine, New England Food Allergy Center, Farmington, Connecticut.
Ann Allergy Asthma Immunol. 2018 Nov;121(5):537-544. doi: 10.1016/j.anai.2018.09.459. Epub 2018 Sep 21.
To review the history of the penicillin minor determinants and evaluate their relevance for current diagnosis.
Skin testing to detect immunoglobulin E (IgE) sensitivity to penicillins in patients with a history of penicillin allergy has been the subject of more than 55 years of published research involving tens of thousands of patients.
Selection of data was based on its relevance to the objective of this article.
It was established early on that testing with the major penicilloyl determinant using the polyvalent penicilloyl-polylysine (PPL) is negative in a substantial portion (10% to 64%, including recent increases) of those at risk for immediate hypersensitivity reactions. A variety of minor penicillin determinants are clinically significant in that their use in skin testing is essential to detect all those at risk. In particular, a minor determinant mixture of benzylpenicillin, benzylpenicilloate, and benzylpenilloate, used in conjunction with PPL, has been shown in numerous studies to achieve an average negative predictive value (NPV) of 97.9% in history-positive patients. Benzylpenicillin alone, as the sole minor determinant, leaves many skin test-positive patients undiscovered. Use of amoxicillin as an additional minor determinant reagent appears to identify another 2% to 8% of skin test-positive patients in some populations.
IgE skin testing, using both the major and appropriate minor determinants of penicillin, can identify, with a high degree of reliability (NPV ∼97%), penicillin allergy history-positive patients who can receive beta-lactam antibiotics without concern for serious acute allergy, including anaphylaxis. The few false-negative skin tests reported globally are largely confined to minor, self-limited cutaneous reactions.
回顾青霉素次要决定簇的历史，并评估其对当前诊断的相关性。
对青霉素过敏史患者进行皮肤试验以检测免疫球蛋白 E（IgE）对青霉素的敏感性，这是 55 多年来涉及成千上万患者的 55 多年来发表的研究的主题。
根据与本文目标的相关性选择数据。
早期就确定了使用多价青霉素酰基-多聚赖氨酸（PPL）检测主要青霉素酰基决定簇的方法在很大一部分（包括最近的增加）有即刻过敏反应风险的患者中呈阴性。许多次要的青霉素决定簇具有临床意义，因为它们在皮肤试验中的使用对于检测所有有风险的患者至关重要。特别是，使用苯唑西林、苯唑西林酸和苯唑西林酸的混合物作为次要决定簇的混合物，与 PPL 一起使用，已在许多研究中显示，在阳性病史患者中平均阴性预测值（NPV）为 97.9％。单独使用苯唑西林作为唯一的次要决定簇，会使许多皮肤试验阳性的患者未被发现。在某些人群中，使用阿莫西林作为额外的次要决定簇试剂似乎可以另外识别出 2％至 8％的皮肤试验阳性患者。
使用青霉素的主要和适当的次要决定簇进行 IgE 皮肤试验，可以可靠地（NPV≈97％）识别出青霉素过敏史阳性的患者，这些患者可以使用β-内酰胺类抗生素而不必担心严重的急性过敏，包括过敏反应。全球报告的少数假阴性皮肤试验主要局限于较小的、自限性皮肤反应。
