主要和次要决定簇在青霉素过敏试验中的作用：是时候重新审视一位老朋友了？
The role of major and minor determinants in penicillin allergy testing: Time to revisit an old friend?
作者信息
Ali Syed B, Le Thanh-Thao Adriana, Ahmadie Aida, Yuson Chino, Kette Frank, Hissaria Pravin, Smith William B
机构信息
Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia.
Department of Immunopathology, SA Pathology, Adelaide, Australia.
出版信息
J Allergy Clin Immunol Glob. 2023 Jul 3;2(4):100132. doi: 10.1016/j.jacig.2023.100132. eCollection 2023 Nov.
BACKGROUND
Skin testing is an important step in evaluation of penicillin allergic reactions. It includes testing to the following: amoxicillin, benzyl penicillin, and products generated after penicillin administration, the major determinant hapten penicilloyl-polylysine (PPL) and the minor determinant mixture (MDM). Although PPL and MDM are available as a commercial kit, their supply and cost remain problematic.
OBJECTIVE
We aimed to evaluate the performance and utility of PPL and MDM in penicillin allergy testing.
METHODS
A retrospective audit over a 5-year period was undertaken for those with penicillin testing in a tertiary immunology unit.
RESULTS
In all, 214 patients were identified. Of those patients, 151 (70.6%) were female and the average age was 58 years. Unspecified penicillin was the most common index drug (n = 127 [59.3%]), followed by amoxicillin (n =3 [24.8%]) and amoxicillin-clavulanic acid (n = 21 [9.7%]). The result of skin testing was positive in 23 patients (10.7%); skin prick testing was positive in 10 patients (4.7%), and intradermal testing (IDT) was positive in 13 patients (6.1%), the majority of whom had identified amoxicillin or amoxicillin-clavulanic acid as the index drug (n = 22 [95.7%]). The result of testing to PPL and/or MDM was positive with IDT only (n=5 [23.8%]). PPL and MDM positivity coexisted with a positive reaction to amoxicillin IDT in 2 patients, 1 of whom passed an amoxicillin challenge. Additionally, 2 positive tests to PPL were present with a negative result for MDM; of these 2 positive results, 1 was positive to amoxicillin IDT. In only 1 case were the results of testing for MDM and PPL both positive, with negative results to all native β-lactams tested; the patient tolerated an amoxicillin challenge. Overall, the negative predictive value for both skin prick testing and IDT was 89.5%.
CONCLUSION
Benzyl penicillin and amoxicillin alone may be sufficient for testing in suspected individuals with penicillin allergy.
背景
皮肤试验是评估青霉素过敏反应的重要步骤。它包括对以下物质进行检测：阿莫西林、苄青霉素以及青霉素给药后产生的产物、主要决定簇半抗原青霉噻唑聚赖氨酸（PPL）和次要决定簇混合物（MDM）。尽管PPL和MDM有商用试剂盒，但它们的供应和成本仍然存在问题。
目的
我们旨在评估PPL和MDM在青霉素过敏试验中的性能和效用。
方法
对一家三级免疫科进行青霉素检测的患者进行了为期5年的回顾性审计。
结果
共确定了214例患者。在这些患者中，151例（70.6%）为女性，平均年龄为58岁。未指明的青霉素是最常见的索引药物（n = 127 [59.3%]），其次是阿莫西林（n = 3 [24.8%]）和阿莫西林-克拉维酸（n = 21 [9.7%]）。皮肤试验结果在23例患者中呈阳性（10.7%）；皮肤点刺试验在10例患者中呈阳性（4.7%），皮内试验（IDT）在13例患者中呈阳性（6.1%），其中大多数患者将阿莫西林或阿莫西林-克拉维酸确定为索引药物（n = 22 [95.7%]）。PPL和/或MDM的检测结果仅皮内试验呈阳性（n = 5 [23.8%]）。2例患者中PPL和MDM阳性与阿莫西林IDT阳性反应共存，其中1例通过了阿莫西林激发试验。此外，2例PPL检测呈阳性而MDM检测结果为阴性；在这2例阳性结果中，1例对阿莫西林IDT呈阳性。仅1例患者MDM和PPL检测结果均为阳性，而所有检测的天然β-内酰胺类药物结果均为阴性；该患者耐受阿莫西林激发试验。总体而言，皮肤点刺试验和IDT的阴性预测值均为89.5%。
结论
对于疑似青霉素过敏的个体，单独使用苄青霉素和阿莫西林可能足以进行检测。
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