Alharbi Homood A
Homood A. Alharbi is an assistant professor, College of Nursing, King Saud University, Riyadh, Saudi Arabia.
Crit Care Nurse. 2019 Dec 1;39(6):e1-e9. doi: 10.4037/ccn2019207.
Recent research has shown that a large majority of patients with a history of penicillin allergy are acutely tolerant of penicillins and that there is no clinically significant immunologic cross-reactivity between penicillins and cephalosporins or other β-lactams. The standard test to confirm acute tolerance is challenge with a therapeutic dose. Skin testing is useful only when the culprit antibiotic can haptenate serum proteins and induce an immunoglobulin E-mediated reaction and the clinical history demonstrates such high risk that a direct oral challenge may result in anaphylaxis.
To review and evaluate the current practice of skin testing for antibiotics (other than penicillin) in critically ill patients by means of a systematic literature review.
This systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Several electronic databases were searched using the following terms: antibiotics, skin test (tests, testing), intensive care, intensive care unit, ICU, critical care, critical care unit.
Twenty-three articles were identified for inclusion in this review. The results indicate a lack of standardized skin testing for all antibiotics in critical care settings. Oral challenge with nonirritating concentrations of antibiotics can be helpful in determining allergy to these drugs.
Critical care providers should evaluate antibiotic allergy using nonirritating concentrations before administering antibiotics to patients. Introduction of a standardized skin test for all antibiotics in intensive care unit patients to help select the most appropriate antibiotic treatment regimen might help save lives and reduce costs.
最近的研究表明，绝大多数有青霉素过敏史的患者对青霉素具有急性耐受性，并且青霉素与头孢菌素或其他β-内酰胺类药物之间不存在具有临床意义的免疫交叉反应。确认急性耐受性的标准测试是给予治疗剂量进行激发试验。皮肤试验仅在可疑抗生素能够使血清蛋白半抗原化并引发免疫球蛋白E介导的反应，且临床病史显示直接口服激发试验可能导致过敏反应的高风险时才有用。
通过系统的文献综述，回顾和评估重症患者对抗生素（非青霉素）进行皮肤试验的当前做法。
本系统综述按照PRISMA（系统评价和Meta分析的首选报告项目）指南进行。使用以下术语检索了几个电子数据库：抗生素、皮肤试验（测试、检测）、重症监护、重症监护病房、ICU、危重症护理、危重症护理病房。
确定了23篇文章纳入本综述。结果表明，在重症监护环境中，所有抗生素的皮肤试验缺乏标准化。使用无刺激性浓度的抗生素进行口服激发试验有助于确定对这些药物的过敏情况。
重症监护提供者在给患者使用抗生素之前，应使用无刺激性浓度评估抗生素过敏情况。在重症监护病房患者中引入针对所有抗生素的标准化皮肤试验，以帮助选择最合适的抗生素治疗方案，可能有助于挽救生命并降低成本。
