Wickern G M, Nish W A, Bitner A S, Freeman T M
Department of Allergy-Immunology, Wilford Hall USAF Medical Center, San Antonio, TX 78236-5400.
J Allergy Clin Immunol. 1994 Oct;94(4):725-31. doi: 10.1016/0091-6749(94)90180-5.
Many issues related to the diagnosis and management of beta-lactam drug allergy still await definitive recommendations. To determine how practicing allergists deal with some of these dilemmas, a questionnaire was mailed to 3500 physician members and fellows of the American Academy of Allergy and Immunology. It was also sent to each of the allergy training program directors in the United States to determine what is currently taught to fellows in training. Benzylpenicilloyl-polylysine (Pre-Pen) and fresh penicillin G are used for skin testing by more than 86% of both respondent groups, whereas minor determinant mixtures are used by only 40%. Epicutaneous followed by intradermal injection was the skin test technique used by 86% of these allergists. More than 90% said they would skin test in cases of reaction history of urticaria, whereas only 1.5% would test in cases of family history of penicillin allergy. Practicing allergists and program directors differed slightly when queried about cephalosporin cross-reactivity. Program directors were more cautious in their use of cephalosporins with patients allergic to penicillin. Program directors were also more likely to repeat skin testing before future penicillin courses than were practicing allergists. Clearly, some individual approaches to the diagnosis and management of beta-lactam allergy are practiced. Development of practice guidelines by our professional organizations may be useful.
许多与β-内酰胺类药物过敏的诊断和管理相关的问题仍有待明确的建议。为了确定执业过敏症专科医生如何处理其中一些困境，向美国过敏、哮喘与免疫学会的3500名医师会员和研究员邮寄了一份调查问卷。该问卷还发送给了美国每个过敏培训项目的主任，以确定目前培训学员的内容。超过86%的两个应答组使用苄青霉素酰聚赖氨酸（预青霉素）和新鲜青霉素G进行皮肤试验，而只有40%的人使用次要决定簇混合物。86%的这些过敏症专科医生采用的皮肤试验技术是先进行皮试，然后进行皮内注射。超过90%的人表示，对于有荨麻疹反应史的病例会进行皮肤试验，而对于有青霉素过敏家族史的病例，只有1.5%的人会进行试验。在询问头孢菌素交叉反应性时，执业过敏症专科医生和项目主任的看法略有不同。项目主任在对青霉素过敏的患者使用头孢菌素时更为谨慎。与执业过敏症专科医生相比，项目主任也更有可能在未来的青霉素疗程之前重复进行皮肤试验。显然，在β-内酰胺类过敏的诊断和管理方面存在一些个人化的方法。我们的专业组织制定实践指南可能会有所帮助。
