Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
Int Arch Allergy Immunol. 2021;182(9):827-834. doi: 10.1159/000515080. Epub 2021 Apr 19.
Intradermal testing with delayed reading (IDTdr), used routinely in many centers, may identify delayed reactions to penicillins. However, few studies have compared the results of IDTdr with drug provocation test (DPT). The aim of this study was to examine the proportion of provocation-positive patients testing positive on IDTdr.
Fifty-seven patients with a positive DPT occurring >2 h after intake of penicillin V, dicloxacillin, pivampicillin, or amoxicillin had an IDTdr with penicillin G, amoxicillin, ampicillin, and dicloxacillin. A control group included 18 patients with negative DPTs with the suspected penicillin.
In total 25% (n = 14) of provocation-positive patients tested positive on IDTdr. Among patients with positive IDTdr, 9/14 (64%) versus 11/43 (26%) in the IDTdr negative group (p < 0.05) had required oral steroids to treat skin reactions following DPT. No other differences between IDTdr positive and negative groups were found. No controls had a positive IDTdr.
Investigating with IDTdr would have identified 25% of patients with a DPT-verified allergy with delayed reactions. It is difficult to target subgroups who will test positive on IDTdr. There were more patients who tested positive on IDT who had received oral steroids after DPT, and this may be an indication that skin reaction severity plays a role in skin testing diagnostics. Further potential predictors for positivity of IDTdr, such as duration of skin symptoms, should be assessed in large studies in order to optimize the investigations of nonimmediate drug allergic reactions.
在许多中心，常规使用皮内试验（IDTdr）进行延迟读数，这可能会识别出对青霉素的延迟反应。然而，很少有研究比较 IDTdr 与药物激发试验（DPT）的结果。本研究旨在检查激发阳性患者中 IDTdr 阳性的比例。
57 例青霉素 V、双氯西林、匹美西林或阿莫西林激发试验阳性>2 小时的患者进行 IDTdr，检测青霉素 G、阿莫西林、氨苄西林和双氯西林。对照组包括 18 例可疑青霉素激发试验阴性的患者。
总共有 25%（n = 14）的激发阳性患者 IDTdr 阳性。在 IDTdr 阳性的患者中，9/14（64%）比 IDTdr 阴性组的 11/43（26%）（p < 0.05）需要口服类固醇来治疗 DPT 后的皮肤反应。IDTdr 阳性和阴性组之间没有发现其他差异。对照组中没有患者 IDTdr 阳性。
通过 IDTdr 检测，可能会发现 25%的 DPT 证实过敏且延迟反应的患者。很难确定 IDTdr 阳性的亚组。IDTdr 阳性的患者中，有更多的患者在 DPT 后接受了口服类固醇治疗，这可能表明皮肤反应的严重程度在皮肤测试诊断中起作用。为了优化非即刻药物过敏反应的检测，应在大型研究中评估 IDTdr 阳性的其他潜在预测因子，如皮肤症状持续时间。
