Johns Hopkins University, Baltimore, Md.
Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
J Allergy Clin Immunol Pract. 2024 Nov;12(11):3025-3033.e6. doi: 10.1016/j.jaip.2024.07.028. Epub 2024 Aug 6.
Vancomycin infusion reaction (VIR), reportedly mediated through Mas-Related G Protein-Coupled Receptor-X2, is the primary vancomycin-induced immediate drug reaction. Clinically, distinguishing the underlying drug-induced immediate drug reaction mechanisms is crucial for future treatment strategies, including drug restriction, re-administration, and pretreatment considerations. However, the lack of validated diagnostic tests makes this challenging, often leading to unnecessary drug restriction.
To determine whether intradermal tests (IDTs) and, separately, the basophil activation test (BAT) differentiate VIR from vancomycin-tolerant subjects.
This was a cross-sectional study of vancomycin-exposed adults with and without a history of VIR. Data on demographics, allergy-related comorbidities, history of vancomycin exposures, and VIR characteristics were collected. IDT with vancomycin was performed. IDT dose-response EC, IDT-related local symptoms, and BAT results were compared between groups.
A total of 11 VIR and 10 vancomycin-tolerant subjects were enrolled. The most reported VIR symptoms were pruritus (82%), flushing (82%), hives (46%), angioedema (27%), and dyspnea (19%). The IDT dose-response mean EC was 328 μg/mL (95% CI, 296-367) in the VIR versus 1166 μg/mL (95% CI, 1029-1379) in the tolerant group (P < .0001). All VIR subjects reported IDT-related local pruritus compared with 60% of tolerant subjects (P = .0185). The %CD63 basophils were consistently less than 2%, without significant differences between groups (P < .54).
Variations in skin test methodologies could help identify other immediate drug reaction mechanisms beyond IgE. This skin test protocol holds the potential for identifying VIR, particularly in cases where patients have received multiple drugs while BAT is insufficient. Future studies will validate and delineate its predictive value, assessing the risk of VIR.
据报道，万古霉素输注反应（VIR）是由 Mas 相关 G 蛋白偶联受体 X2 介导的，是万古霉素引起的主要即刻药物反应。临床上，区分潜在的药物引起的即刻药物反应机制对于未来的治疗策略至关重要，包括药物限制、重新给药和预处理考虑。然而，缺乏经过验证的诊断测试使得这具有挑战性，往往导致不必要的药物限制。
确定皮内试验（IDT）和单独的嗜碱性粒细胞活化试验（BAT）是否可区分 VIR 与对万古霉素耐受的受试者。
这是一项横断面研究，纳入了有和无 VIR 史的万古霉素暴露成年人。收集了人口统计学、与过敏相关的合并症、万古霉素暴露史和 VIR 特征的数据。进行了万古霉素皮内试验。比较了两组之间 IDT 剂量反应 EC、IDT 相关局部症状和 BAT 结果。
共纳入 11 例 VIR 患者和 10 例对万古霉素耐受的患者。报告的最常见 VIR 症状是瘙痒（82%）、潮红（82%）、荨麻疹（46%）、血管性水肿（27%）和呼吸困难（19%）。VIR 组的 IDT 剂量反应平均 EC 为 328μg/mL（95%CI，296-367），而耐受组为 1166μg/mL（95%CI，1029-1379）（P<.0001）。与 60%的耐受患者相比，所有 VIR 患者均报告 IDT 相关的局部瘙痒（P=.0185）。两组之间的 %CD63 嗜碱性粒细胞均持续低于 2%，无显著差异（P<.54）。
皮肤试验方法的变化可以帮助确定除 IgE 以外的其他即刻药物反应机制。这种皮肤试验方案有可能识别 VIR，特别是在患者同时接受多种药物而 BAT 不足的情况下。未来的研究将验证和描绘其预测价值，评估 VIR 的风险。
