Lee T M, Grammer L C, Shaughnessy M A, Patterson R
J Allergy Clin Immunol. 1987 Jun;79(6):964-8. doi: 10.1016/0091-6749(87)90248-x.
Subsequent use of an adrenocorticotropic hormone (ACTH) preparation may be considered in some instances in a patient who has demonstrated a suspected or proven allergic reaction to corticotropin on prior administration. We describe a patient with multiple sclerosis with a history of anaphylaxis to porcine ACTH in whom another course of treatment with ACTH was being considered. The patient had immediate cutaneous reactivity to porcine ACTH but not to the synthetic ACTH peptide, cosyntropin. With a test-dose schedule, we were able to uneventfully administer cosyntropin to the patient. The presence of serum IgE antibody directed against porcine ACTH and absence of IgE antibody against cosyntropin were demonstrated by ELISA technique, corroborating the skin test results. These studies are consistent with previous evidence that immediate hypersensitivity reactions to corticotropin are IgE mediated and support the value of skin testing in the clinical evaluation and management of known or suspected corticotropin hypersensitivity.
对于先前使用促肾上腺皮质激素（ACTH）制剂时已出现疑似或确诊过敏反应的患者，在某些情况下可考虑后续使用ACTH制剂。我们描述了一名患有多发性硬化症且有猪ACTH过敏史的患者，正在考虑对其进行另一疗程的ACTH治疗。该患者对猪ACTH有即刻皮肤反应，但对合成ACTH肽（促肾上腺皮质激素）无反应。按照试验剂量方案，我们得以顺利地给该患者使用促肾上腺皮质激素。通过ELISA技术证实了针对猪ACTH的血清IgE抗体的存在以及针对促肾上腺皮质激素的IgE抗体的缺失，这与皮肤试验结果相互印证。这些研究与先前的证据一致，即对促肾上腺皮质激素的即刻超敏反应是由IgE介导的，并支持皮肤试验在已知或疑似促肾上腺皮质激素超敏反应的临床评估和管理中的价值。
