Vega J M, Blanca M, García J J, Carmona M J, Miranda A, Pérez-Estrada M, Fernández S, Acebes J M, Terrados S
Allergy Section, Carlos Haya Regional Hospital, Málaga, Spain.
Allergy. 1994 May;49(5):317-22. doi: 10.1111/j.1398-9995.1994.tb02275.x.
A large group of patients with suspected allergic reactions to beta-lactam antibiotics was evaluated. A detailed clinical history, together with skin tests, RAST (radioallergosorbent test), and controlled challenge tests, was used to establish whether patients allergic to beta-lactam antibiotics had selective immediate allergic responses to amoxicillin (AX) or were cross-reacting with other penicillin derivatives. Skin tests were performed with benzylpenicilloyl-poly-L-lysine (BPO-PLL), benzylpenicilloate, benzylpenicillin (PG), ampicillin (AMP), and AX. RAST for BPO-PLL and AX-PLL was done. When both skin test and RAST for BPO were negative, single-blind, placebo-controlled challenge tests were done to ensure tolerance of PG or sensitivity to AX. A total of 177 patients were diagnosed as allergic to beta-lactam antibiotics. We selected the 54 (30.5%) cases of immediate AX allergy with good tolerance of PG. Anaphylaxis was seen in 37 patients (69%), the other 17 (31%) having urticaria and/or angioedema. All the patients were skin test negative to BPO; 49 of 51 (96%) were also negative to MDM, and 44 of 46 (96%) to PG. Skin tests with AX were positive in 34 (63%) patients. RAST was positive for AX in 22 patients (41%) and to BPO in just 5 (9%). None of the sera with negative RAST for AX were positive to BPO. Challenge tests with AX were performed in 23 subjects (43%) to establish the diagnosis of immediate allergic reaction to AX, and in 15 cases (28%) both skin test and RAST for AX were negative. PG was well tolerated by all 54 patients. We describe the largest group of AX-allergic patients who have tolerated PG reported so far. Diagnosis of these patients can be achieved only if specific AX-related reagents are employed. Further studies are necessary to determine the exact extent of this problem and to improve the efficacy of diagnostic methods.
对一大组疑似对β-内酰胺类抗生素过敏的患者进行了评估。通过详细的临床病史，结合皮肤试验、放射性变应原吸附试验（RAST）和对照激发试验，来确定对β-内酰胺类抗生素过敏的患者是对阿莫西林（AX）有选择性速发型过敏反应，还是与其他青霉素衍生物发生交叉反应。用苄青霉素酰聚-L-赖氨酸（BPO-PLL）、苄青霉素酯、苄青霉素（PG）、氨苄青霉素（AMP）和AX进行皮肤试验。进行了针对BPO-PLL和AX-PLL的RAST检测。当BPO的皮肤试验和RAST均为阴性时，进行单盲、安慰剂对照激发试验，以确保对PG耐受或对AX敏感。共有177例患者被诊断为对β-内酰胺类抗生素过敏。我们选取了54例（30.5%）对AX速发型过敏且对PG耐受性良好的病例。37例患者（69%）出现过敏反应，另外17例（31%）有荨麻疹和/或血管性水肿。所有患者对BPO的皮肤试验均为阴性；51例中的49例（96%）对MDM也为阴性，46例中的44例（96%）对PG为阴性。34例（63%）患者对AX的皮肤试验呈阳性。22例患者（41%）的AX-RAST呈阳性，仅5例（9%）对BPO呈阳性。AX-RAST阴性的血清中无一例对BPO呈阳性。对23例受试者（43%）进行了AX激发试验以确诊对AX的速发型过敏反应，15例（28%）患者对AX的皮肤试验和RAST均为阴性。所有54例患者对PG耐受性良好。我们描述了迄今为止报道的对PG耐受的最大一组AX过敏患者。只有使用特定的AX相关试剂才能确诊这些患者。有必要进一步研究以确定该问题的确切程度并提高诊断方法的有效性。
