Cox Fionnuala, Holmes Natasha E, Waldron Jamie Lee, Trubiano Jason A
Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia.
Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.
J Allergy Clin Immunol Glob. 2024 Aug 5;3(4):100320. doi: 10.1016/j.jacig.2024.100320. eCollection 2024 Nov.
Penicillin-associated exanthems in the setting of infectious mononucleosis caused by Epstein-Barr virus (EBV) are often viewed as a transient event, not a true allergy. Recent evidence challenges this and suggests that a notable subset of patients retain penicillin hypersensitivity.
We investigated the occurrence and predictors of persistent adulthood hypersensitivity in those with penicillin-associated rash occurring in the setting of EBV infection.
Retrospective analysis of data of patients referred for penicillin allergy testing to an Australian tertiary-care hospital captured from 2015 to 2023 was carried out.
Of 2066 patients, 23 (1%) had penicillin-associated rash during an historic EBV infection; 16 (70%) were female; and median (interquartile range) age was 18 (16-20) years at index reaction and 38 (33.5-57) years at allergy testing. Skin prick testing and delayed intradermal testing to a penicillin panel were performed, followed by oral provocation challenge in those testing negative. Persistent sensitization was shown in 6 (26%) of 23; 4 (67%) of 6 positive delayed intradermal testing; and 3 (50%) of 6 had positive oral challenge test. Notably, 5 (83%) of 6 had a severe maculopapular exanthem with facial swelling, including 2 (33%) of 6 with probable drug reaction with eosinophilia and systemic symptoms (aka DRESS) during the index reaction, compared to 0 of 17 in patients tolerating penicillin on reexposure.
This study highlights the requirement of allergy testing in adult patients reporting a penicillin-associated severe maculopapular exanthem in the setting of EBV, even if it occurred during childhood or adolescence.
在由爱泼斯坦-巴尔病毒（EBV）引起的传染性单核细胞增多症背景下，青霉素相关的皮疹通常被视为一种短暂事件，而非真正的过敏。最近的证据对此提出了质疑，并表明相当一部分患者存在青霉素超敏反应。
我们调查了在EBV感染背景下出现青霉素相关皮疹的患者中持续性成人超敏反应的发生率及预测因素。
对2015年至2023年转诊至澳大利亚一家三级护理医院进行青霉素过敏检测的患者数据进行回顾性分析。
在2066例患者中，23例（1%）在既往EBV感染期间出现青霉素相关皮疹；16例（70%）为女性；初次反应时的中位（四分位间距）年龄为l8（16 - 20）岁，过敏检测时为38（33.5 - 57）岁。对青霉素组进行了皮肤点刺试验和延迟皮内试验，对检测阴性的患者进行了口服激发试验。23例中有6例（26%）显示持续性致敏；6例皮内试验延迟阳性者中有4例（67%）；6例口服激发试验阳性者中有3例（50%）。值得注意的是，6例中有5例（83%）出现严重的斑丘疹并伴有面部肿胀，其中6例中有2例（33%）在初次反应时可能出现伴有嗜酸性粒细胞增多和全身症状的药物反应（即药物超敏反应伴嗜酸性粒细胞增多和全身症状，简称DRESS），而再次接触青霉素时耐受的17例患者中无1例出现此情况。
本研究强调，对于报告在EBV感染背景下出现青霉素相关严重斑丘疹的成年患者，即使皮疹发生在儿童期或青春期，也需要进行过敏检测。
