Moss R B, Babin S, Hsu Y P, Blessing-Moore J, Lewiston N J
J Pediatr. 1984 Mar;104(3):460-6. doi: 10.1016/s0022-3476(84)81117-8.
Allergic reactions to anti-Pseudomonal penicillin derivatives are an increasing problem in therapy of cystic fibrosis lung disease. We evaluated 15 patients, ages 12 to 37 years, with documented allergic reactions to carbenicillin, ticarcillin, or piperacillin. Intradermal skin test reactions were positive for benzylpenicillin in seven patients, penicilloyl-polylysine in one, and ticarcillin or piperacillin in eight, for a total of 11 of 11 tested. Results of radioallergosorbent testing to penicilloyl conjugates were positive in eight of 14 patients and equivocal in four others. Overall, skin tests or RAST results were positive in 13 of 15 patients. All patients were desensitized with a semisynthetic penicillin by continuous serial intravenous infusion of 10-fold dose increments, beginning with 10(-6) of the therapeutic dose. Desensitization was successful in 25 of 26 instances. After intravenously administered therapy, maintenance of desensitization with dicloxacillin orally was unsuccessful in four of six patients. We conclude that (1) allergy to semisynthetic penicillins in cystic fibrosis usually is IgE mediated; (2) such allergy can be evaluated by skin testing; (3) it can be safely and in most cases successfully treated by intravenous desensitization; and (4) allergic patients should be desensitized on each subsequent admission for intravenously administered therapy.
在囊性纤维化肺病治疗中，对抗假单胞菌青霉素衍生物的过敏反应是一个日益严重的问题。我们评估了15例年龄在12至37岁之间、有羧苄西林、替卡西林或哌拉西林过敏反应记录的患者。11例接受检测的患者中，皮内皮肤试验反应显示，7例对苄青霉素呈阳性，1例对青霉噻唑酰聚赖氨酸呈阳性，8例对替卡西林或哌拉西林呈阳性，共计11例阳性。14例患者中8例对青霉噻唑酰结合物的放射变应原吸附试验结果呈阳性，另外4例结果不明确。总体而言，15例患者中有13例皮肤试验或放射变应原吸附试验结果呈阳性。所有患者均通过连续静脉输注10倍剂量递增的半合成青霉素进行脱敏，起始剂量为治疗剂量的10^(-6)。26例中有25例脱敏成功。静脉给药治疗后，6例患者中有4例口服双氯西林维持脱敏未成功。我们得出结论：(1)囊性纤维化患者对半合成青霉素的过敏通常由IgE介导；(2)这种过敏可通过皮肤试验评估；(3)通过静脉脱敏可安全且在大多数情况下成功治疗；(4)过敏患者在每次后续入院接受静脉给药治疗时均应进行脱敏。
