特异性IgE在青霉素过敏调查中的临床相关性
Clinical Relevance of Specific IgE in Penicillin Allergy Investigation.
作者信息
Lendal Victor, Fransson Sara, Mosbech Holger, Boel Jonas Bredtoft, Kahlhofen Natasha, Blom Lars H, Poulsen Lars K, Garvey Lene H
机构信息
Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
Department of Clinical Microbiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
出版信息
Int Arch Allergy Immunol. 2025;186(4):303-310. doi: 10.1159/000541243. Epub 2024 Oct 25.
INTRODUCTION
Patients with immediate type allergic reactions to penicillins are at risk of anaphylaxis on reexposure. Diagnostic gold standard is drug provocation test (DPT) if allergy is not diagnosed by other means, such as skin testing or in vitro testing with measurement of specific IgE. Specific IgE testing carries low risk for the patient and blood sampling can be performed in primary care, but it is reported to have low sensitivity. The aim of this study was to evaluate if clinical characteristics of patients with suspected allergic reactions to penicillin and elevated specific IgE to penicillins, differed from patients without specific IgE, to identify predictors for elevated specific IgE to penicillins.
METHODS
Levels of specific IgE to five penicillins (penicillin G, penicillin V, amoxicillin, ampicillin, and penicillin minor determinants) were available for 9,100 patients. Using multiple logistic regression, clinical data from 430 patients in this group who had elevated specific IgE to one or more penicillins were compared to data from 4,094 patients without specific IgE to penicillins, who had undergone DPT with a penicillin.
RESULTS
In total 5.2% of patients had elevated specific IgE to one or more penicillins. Significantly more patients with elevated specific IgE had a history of immediate type reactions (<2 h) (OR = 4.34, p < 0.001); circulatory symptoms (OR = 1.63, p = 0.03) or angioedema (OR = 1.46, p = 0.005). Also, significantly more patients with elevated specific IgE had been treated with adrenaline (OR = 2.21, p = 0.005), steroids (OR = 1.76, p < 0.001), or antihistamines (OR = 1.83, p < 0.001).
CONCLUSION
A history of an immediate type reaction requiring treatment, combined with elevated specific IgE to one or more penicillins is suggestive of an IgE mediated penicillin allergy and further allergy investigations may not be needed. Specific IgE to penicillins may be used early in allergy investigation of patients with severe immediate type reactions to penicillins.
INTRODUCTION
Patients with immediate type allergic reactions to penicillins are at risk of anaphylaxis on reexposure. Diagnostic gold standard is drug provocation test (DPT) if allergy is not diagnosed by other means, such as skin testing or in vitro testing with measurement of specific IgE. Specific IgE testing carries low risk for the patient and blood sampling can be performed in primary care, but it is reported to have low sensitivity. The aim of this study was to evaluate if clinical characteristics of patients with suspected allergic reactions to penicillin and elevated specific IgE to penicillins, differed from patients without specific IgE, to identify predictors for elevated specific IgE to penicillins.
METHODS
Levels of specific IgE to five penicillins (penicillin G, penicillin V, amoxicillin, ampicillin, and penicillin minor determinants) were available for 9,100 patients. Using multiple logistic regression, clinical data from 430 patients in this group who had elevated specific IgE to one or more penicillins were compared to data from 4,094 patients without specific IgE to penicillins, who had undergone DPT with a penicillin.
RESULTS
In total 5.2% of patients had elevated specific IgE to one or more penicillins. Significantly more patients with elevated specific IgE had a history of immediate type reactions (<2 h) (OR = 4.34, p < 0.001); circulatory symptoms (OR = 1.63, p = 0.03) or angioedema (OR = 1.46, p = 0.005). Also, significantly more patients with elevated specific IgE had been treated with adrenaline (OR = 2.21, p = 0.005), steroids (OR = 1.76, p < 0.001), or antihistamines (OR = 1.83, p < 0.001).
CONCLUSION
A history of an immediate type reaction requiring treatment, combined with elevated specific IgE to one or more penicillins is suggestive of an IgE mediated penicillin allergy and further allergy investigations may not be needed. Specific IgE to penicillins may be used early in allergy investigation of patients with severe immediate type reactions to penicillins.
引言
对青霉素发生速发型过敏反应的患者再次接触时存在过敏反应风险。如果通过其他方法（如皮肤试验或检测特异性IgE的体外试验）未诊断出过敏，则诊断金标准是药物激发试验（DPT）。特异性IgE检测对患者风险较低，且可在初级保健机构进行血样采集，但据报道其敏感性较低。本研究的目的是评估疑似青霉素过敏反应且青霉素特异性IgE升高的患者的临床特征是否与无特异性IgE的患者不同，以确定青霉素特异性IgE升高的预测因素。
方法
9100例患者有针对五种青霉素（青霉素G、青霉素V、阿莫西林、氨苄西林和青霉素次要决定簇）的特异性IgE水平数据。使用多因素逻辑回归，将该组中430例青霉素特异性IgE升高至一种或多种的患者的临床数据与4094例青霉素特异性IgE未升高且接受过青霉素DPT的患者的数据进行比较。
结果
共有5.2%的患者青霉素特异性IgE升高至一种或多种。青霉素特异性IgE升高的患者有速发型反应（<2小时）病史的显著更多（比值比[OR]=4.34，p<0.001）；有循环系统症状（OR=1.63，p = 0.03）或血管性水肿（OR=1.46，p = 0.005）的也显著更多。此外，青霉素特异性IgE升高的患者接受肾上腺素治疗（OR=2.21，p = 0.005）、类固醇治疗（OR=1.76，p<0.001）或抗组胺药治疗（OR=1.83，p<0.001）的也显著更多。
结论
有需要治疗的速发型反应病史，同时青霉素特异性IgE升高至一种或多种提示IgE介导的青霉素过敏，可能无需进一步的过敏检查。青霉素特异性IgE可在对青霉素有严重速发型反应的患者的过敏检查中早期使用。
引言
对青霉素发生速发型过敏反应的患者再次接触时存在过敏反应风险。如果通过其他方法（如皮肤试验或检测特异性IgE的体外试验）未诊断出过敏，则诊断金标准是药物激发试验（DPT）。特异性IgE检测对患者风险较低，且可在初级保健机构进行血样采集，但据报道其敏感性较低。本研究的目的是评估疑似青霉素过敏反应且青霉素特异性IgE升高的患者的临床特征是否与无特异性IgE的患者不同，以确定青霉素特异性IgE升高的预测因素。
方法
9100例患者有针对五种青霉素（青霉素G、青霉素V、阿莫西林、氨苄西林和青霉素次要决定簇）的特异性IgE水平数据。使用多因素逻辑回归，将该组中430例青霉素特异性IgE升高至一种或多种的患者的临床数据与4094例青霉素特异性IgE未升高且接受过青霉素DPT的患者的数据进行比较。
结果
共有5.2%的患者青霉素特异性IgE升高至一种或多种。青霉素特异性IgE升高的患者有速发型反应（<2小时）病史的显著更多（比值比[OR]=4.34，p<0.001）；有循环系统症状（OR=1.63，p = 0.03）或血管性水肿（OR=1.46, p = 0.005）的也显著更多。此外，青霉素特异性IgE升高的患者接受肾上腺素治疗（OR=2.21，p = 0.005）、类固醇治疗（OR=1.76，p<0.001）或抗组胺药治疗（OR=1.83，p<0.001）的也显著更多。
结论
有需要治疗的速发型反应病史，同时青霉素特异性IgE升高至一种或多种提示IgE介导的青霉素过敏，可能无需进一步的过敏检查。青霉素特异性IgE可在对青霉素有严重速发型反应的患者的过敏检查中早期使用。
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