Molina-Molina Gustavo-Jorge, Gómez-Duque Manuel, Vidal Guitart Xavier, Agustí Escasany Antònia, Labrador-Horrillo Moisés, Luengo Olga, Sala-Cunill Anna, Galvan-Blasco Paula, Guilarte Mar, Cardona Victoria
Allergy Department, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain.
Paediatric Allergy Section, Respiratory Paediatric Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
World Allergy Organ J. 2024 May 24;17(6):100914. doi: 10.1016/j.waojou.2024.100914. eCollection 2024 Jun.
Drug provocation tests (DPT) are considered the gold standard procedure to ascertain the diagnosis of beta-lactam (BL) allergy. Regarding route of administration, current recommendations prioritize oral challenges, considering them safer, and reserving the intravenous route for drugs for which this is the only formulation.
To compare in terms of tolerance and safety two protocols of BL DPT, using an oral protocol (OR-DPT) and an intravenous protocol (IV-DPT).
A descriptive, retrospective study was performed, including adult patients who underwent IV-DPT or OR-DPT for suspected immediate or delayed hypersensitivity to BL antibiotics, over a period of 4 years (between January 2018 and December 2021). Demographical data, index hypersensivity reactions' characteristics and tolerance to DPT were reviewed.
A total of 1036 patients underwent DPT, mean age of 56.8 (standard deviation, SD, 17.8) years, 655 were women (63.2%). Immediate drug hypersensitivity reactions (DHR) had occurred in 564 of patients (54.4%). OR-DPT were performed in 439 (42.4%) and IV-DPT in 597 (57.6%). The frequency of reactions during DPT, regardless of the route used, was low (3.6%): only 16 (3.6%) in OR-DPT and 21 (3.5%) in IV-DPT. From IV-DPT, 16 out 21 DHR during DPT were immediate compared with 4 out of 16 in OR-DPT. Adjusted relative risk of developing a hypersensitivity reaction during IV-DPT versus OR-DPT was 1.13 (95% confidence interval (CI)0.57-2.22).
The results suggest that OR-DPT and IV-DPT are both safe procedures when adequately performed. However, IV-DPT protocols showed a higher rate of immediate DHR during DPT probably due to the selection of basal high-risk patients to undergo IV-DPT. In conclusion, IV-DPT may be considered as an option for challenges in drug-allergy studies, entailing a precise administration.
药物激发试验（DPT）被认为是确定β-内酰胺（BL）过敏诊断的金标准程序。关于给药途径，目前的建议优先考虑口服激发试验，认为其更安全，而静脉途径仅用于该药物唯一可用剂型的情况。
比较使用口服方案（OR-DPT）和静脉方案（IV-DPT）的两种BL DPT方案在耐受性和安全性方面的差异。
进行了一项描述性回顾性研究，纳入在4年期间（2018年1月至2021年12月）因怀疑对BL抗生素有速发型或迟发型超敏反应而接受IV-DPT或OR-DPT的成年患者。回顾了人口统计学数据、首次超敏反应的特征以及对DPT的耐受性。
共有1036例患者接受了DPT，平均年龄56.8岁（标准差，SD，17.8），655例为女性（63.2%）。564例患者（54.4%）发生过速发型药物超敏反应（DHR）。439例（42.4%）接受了OR-DPT，597例（57.6%）接受了IV-DPT。无论使用何种途径，DPT期间的反应频率都很低（3.6%）：OR-DPT中仅16例（3.6%），IV-DPT中21例（3.5%）。在IV-DPT中，DPT期间21例DHR中有16例为速发型，而OR-DPT中16例中有4例为速发型。IV-DPT与OR-DPT相比发生超敏反应的调整后相对风险为1.13（95%置信区间（CI）0.57-2.22）。
结果表明，OR-DPT和IV-DPT在操作适当时都是安全的程序。然而，IV-DPT方案在DPT期间速发型DHR的发生率较高，可能是由于选择了基础风险较高的患者进行IV-DPT。总之，IV-DPT可被视为药物过敏研究中激发试验的一种选择，但需要精确给药。
