皮肤试验对侧链青霉素决定簇的反应频率。

The frequency of skin test reactions to side-chain penicillin determinants.

作者信息

Silviu-Dan F, McPhillips S, Warrington R J

机构信息

Department of Medicine, University of Manitoba, Winnipeg, Canada.

出版信息

J Allergy Clin Immunol. 1993 Mar;91(3):694-701. doi: 10.1016/0091-6749(93)90188-l.

DOI:10.1016/0091-6749(93)90188-l

PMID:8454791

Abstract

BACKGROUND

Skin testing for immediate hypersensitivity to penicillins is usually carried out with reagents prepared from benzylpenicillin, and it is believed that side-chain-specific reactions to semisynthetic derivatives are rare. Because some experimental and clinical data suggest that antibodies can be induced to immunogenic epitopes on the side chains of penicillins, we looked for side-chain-specific reactions to skin testing in patients with a history of allergy to penicillins or semisynthetic penicillins.

METHODS

One hundred twelve patients with a clinical history of allergic reactions to penicillins and other semisynthetic penicillins were skin tested an average of 4.9 +/- 0.7 years after their reactions with the major and minor determinants of benzylpenicillin and minor determinant mixtures of ampicillin, amoxicillin, or cloxacillin.

RESULTS

In these patients the most common clinical reactions were urticaria and angioedema (36.6%) and exanthema (48.8%). It was found that 21 cases (18.8%) still exhibited immediate hypersensitivity reactions on skin testing. But of these 21 patients, skin test reactivity was limited in 47.6% to the semisynthetic penicillin reagents derived from ampicillin, amoxicillin, or cloxacillin; that is, skin tests were negative with the benzylpenicillin derivatives. Ampicillin and amoxicillin were the semisynthetic beta-lactams causing most clinical reactions (24.1% and 33.9%, respectively), and ampicillin was the most common penicillin derivative to which skin test reactivity occurred (38.1%), other than the benzylpenicillin derivatives (52.3%).

CONCLUSIONS

IgE antibodies appear therefore to discriminate between benzylpenicillin and ampicillin or other semisynthetic penicillins in a significant proportion of patients allergic to penicillin. Although it has not been proved that side-chain-specific skin reactivity implies the presence of clinically significant immediate hypersensitivity to semisynthetic penicillins, it is possible that side-chain-specific reagents may be required to exclude possible immediate hypersensitivity to the penicillins in patients who reacted to these antibiotics clinically.

摘要

背景

青霉素速发型超敏反应的皮肤试验通常使用由苄青霉素制备的试剂进行，并且人们认为对半合成衍生物的侧链特异性反应很少见。由于一些实验和临床数据表明，抗体可被诱导针对青霉素侧链上的免疫原性表位产生反应，因此我们在有青霉素或半合成青霉素过敏史的患者中寻找皮肤试验的侧链特异性反应。

方法

112例有青霉素和其他半合成青霉素过敏临床病史的患者，在其过敏反应发生后平均4.9±0.7年，用苄青霉素的主要和次要决定簇以及氨苄西林、阿莫西林或氯唑西林的次要决定簇混合物进行皮肤试验。

结果

在这些患者中，最常见的临床反应是荨麻疹和血管性水肿（36.6%）以及皮疹（48.8%）。发现21例（18.8%）患者在皮肤试验时仍表现出速发型超敏反应。但在这21例患者中，47.6%的患者皮肤试验反应性仅限于源自氨苄西林、阿莫西林或氯唑西林的半合成青霉素试剂；也就是说，苄青霉素衍生物的皮肤试验为阴性。氨苄西林和阿莫西林是引起大多数临床反应的半合成β-内酰胺类药物（分别为24.1%和33.9%），除苄青霉素衍生物（52.3%）外，氨苄西林是皮肤试验反应性出现的最常见青霉素衍生物（38.1%）。