Sullivan T J, Wedner H J, Shatz G S, Yecies L D, Parker C W
J Allergy Clin Immunol. 1981 Sep;68(3):171-80. doi: 10.1016/0091-6749(81)90180-9.
Skin testing for penicillin allergy with penicillin G (Pen G), penicilloic acid (PA), and penicilloyl poly-L-lysine (PPL) was performed on 740 subjects, and the results were assessed from epidemiologic and immunologic perspectives. Approximately 95% of these patients had histories of apparent allergic reactions to beta-lactam antibiotics, and 63% were skin-test positive. The prevalence of positive skin tests was related to the time that had elapsed between clinical reactions and skin testing. Ninety-three percent were skin-test positive 7 to 12 mo after reactions, and 22% were positive 10 yr or more after reactions. Patients under 30 yr of age had a prevalence of positive skin tests 1.7-fold higher than older patients. Testing with PPL, PA, and Pen G detected 76.3%, 55.3%, and 57.1% of the positive patients, respectively. Omission of PPL, PA, or Pen G would have led to a failure to detect 25.6%, 7.2%, and 6.2% of the positive patients, respectively. Subjects with skin tests positive to penicillin often reacted to skin tests with other beta-lactam antibiotics; 73% (41 of 56) reacted to ampicillin and 51% (38 of 74) reacted to cephalothin. No serious allergic reactions were provoked by testing. None of the 83 skin test--negative patients treated with beta-lactam antibiotics immediately after testing experienced acute allergic reactions. Two patients developed mild urticaria beginning 3 and 5 days into therapy. One skin test--negative patient experienced urticaria 3 hr after receiving oral penicillin 6 mo after skin testing. This patient's skin-test status immediately before therapy was unknown. These results support the position that testing with PPL, PA, and Pen G is a rapid, safe, and effective method for identifying patients at risk, or not at risk, for allergic reactions to penicillin.
对740名受试者进行了用青霉素G（Pen G）、青霉噻唑酸（PA）和青霉噻唑酰多聚-L-赖氨酸（PPL）进行青霉素过敏皮肤试验，并从流行病学和免疫学角度评估结果。这些患者中约95%有对β-内酰胺类抗生素明显过敏反应的病史，63%皮肤试验呈阳性。皮肤试验阳性的发生率与临床反应和皮肤试验之间经过的时间有关。反应后7至12个月，93%皮肤试验呈阳性，反应后10年或更长时间，22%呈阳性。30岁以下患者皮肤试验阳性的发生率比老年患者高1.7倍。用PPL、PA和Pen G检测分别发现76.3%、55.3%和57.1%的阳性患者。省略PPL、PA或Pen G将分别导致未能检测到25.6%、7.2%和6.2%的阳性患者。对青霉素皮肤试验呈阳性的受试者经常对其他β-内酰胺类抗生素的皮肤试验有反应；73%（56例中的41例）对氨苄西林有反应，51%（74例中的38例）对头孢噻吩有反应。试验未引发严重过敏反应。83名皮肤试验阴性的患者在试验后立即接受β-内酰胺类抗生素治疗，均未出现急性过敏反应。两名患者在治疗开始后3天和5天出现轻度荨麻疹。一名皮肤试验阴性的患者在皮肤试验6个月后口服青霉素3小时后出现荨麻疹。该患者治疗前的皮肤试验状态未知。这些结果支持这样的观点，即使用PPL、PA和Pen G进行检测是一种快速、安全且有效的方法，可用于识别有或没有青霉素过敏反应风险的患者。
