Lapirow Daniel G, Vogrin Sara, De Luca Joseph F, Godsell Jack D, Trubiano Jason A
Centre for Antibiotic Allergy and Research, Department of Infectious Diseases and Immunology, Austin Health, Melbourne, VIC, Australia.
Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
World Allergy Organ J. 2025 May 16;18(6):101063. doi: 10.1016/j.waojou.2025.101063. eCollection 2025 Jun.
In the evaluation of patient-reported penicillin allergy labels (PALs), the utility of skin testing to the penicillin major determinant, known as penicilloyl polylysine (PPL), and to the minor determinant mixture (MDM), has been questioned.
A review of a clinical antibiotic allergy database from April 2015 to December 2023 at Austin Health (Melbourne, Australia) was performed. Patients with PALs who underwent skin prick testing (SPT) and intradermal testing (IDT) to a previously-published standardised beta-lactam panel were selected. Those with positive SPT or IDT to PPL and/or MDM were identified.
A total of 1316 individuals were included in our analysis. Positive skin testing to any reagent was recorded for 168/1316 (12.77%). Positive results to PPL and/or MDM were recorded for 26/1316 (1.98%), including 6 with isolated positive results to PPL and/or MDM, and 20 with additional positive skin testing to at least 1 native penicillin. The number needed to test to confirm 1 additional penicillin allergy with the use of PPL and MDM was calculated at 217.39. Immediate hypersensitivities were reported by all 6 individuals testing positive to the penicillin determinants alone, including 4 with anaphylaxis.
These results suggest limited yield in the routine inclusion of PPL and MDM in skin testing panels, particularly in evaluating delayed hypersensitivities. Restricting their use to select cohorts, such as those with anaphylaxis, may prove more efficient and cost-effective.
在评估患者报告的青霉素过敏标签（PALs）时，针对青霉素主要决定簇（即青霉噻唑聚赖氨酸，PPL）和次要决定簇混合物（MDM）进行皮肤试验的效用受到了质疑。
对澳大利亚墨尔本奥斯汀健康中心2015年4月至2023年12月的临床抗生素过敏数据库进行了回顾。选择了对先前公布的标准化β-内酰胺组进行皮肤点刺试验（SPT）和皮内试验（IDT）的PALs患者。确定了对PPL和/或MDM进行SPT或IDT呈阳性的患者。
共有1316人纳入我们的分析。1316人中168人（12.77%）记录到对任何试剂皮肤试验呈阳性。1316人中26人（1.98%）记录到对PPL和/或MDM呈阳性结果，其中6人对PPL和/或MDM单独呈阳性结果，20人对至少1种天然青霉素皮肤试验额外呈阳性。计算得出使用PPL和MDM确认1例额外青霉素过敏所需检测人数为217.39。仅对青霉素决定簇检测呈阳性的所有6人均报告有速发型超敏反应，其中4人发生过敏反应。
这些结果表明，在皮肤试验组中常规纳入PPL和MDM的收益有限，尤其是在评估迟发型超敏反应方面。将其使用限制在特定队列，如过敏反应患者，可能更有效且更具成本效益。
