Tantawichien T, Benjavongkulchai M, Wilde H, Jaijaroensup W, Siakasem A, Chareonwai S, Yountong C, Sitprija V
Queen Saovabha Memorial Institue (WHO Collaborating Center for Research in Rabies), Chulalongkorn University Hospital, Bangkok, Thailand.
Clin Infect Dis. 1995 Sep;21(3):660-2. doi: 10.1093/clinids/21.3.660.
The high cost of postexposure prophylaxis for rabies is one reason that treatment is inadequate in developing countries. This problem has kindled interest in the use of equine rabies immune globulin, which is a less expensive, yet effective, substitute for human rabies immune globulin. Fatal anaphylaxis is a feared complication of the administration of heterologous serum; therefore, authoritative sources recommend prior skin testing. However, recommendations for methods of administering such a skin test and for its interpretation vary greatly. We embarked on a long-term study to develop guidelines for administration and interpretation of skin test results and to eventually determine a cost-benefit ratio. The skin test is not predictive of serum sickness. Anaphylaxis is rare with modern purified and pepsin-digested equine rabies immune globulins. We consider a skin test to be positive only if a wheal of > 10 mm in diameter, with or without flare, or a wheal of 5-10 mm in diameter with a flare of > 20 mm develops. Long-term studies will be required to answer the remaining questions regarding test criteria and cost benefits.
暴露后狂犬病预防治疗成本高昂，这是发展中国家治疗不足的一个原因。这个问题引发了人们对使用马狂犬病免疫球蛋白的兴趣，它是一种更便宜但同样有效的人狂犬病免疫球蛋白替代品。致命性过敏反应是异种血清给药令人担忧的并发症；因此，权威机构建议进行预先皮肤试验。然而，关于这种皮肤试验的给药方法及其解读的建议差异很大。我们开展了一项长期研究，以制定皮肤试验结果给药和解读的指南，并最终确定成本效益比。皮肤试验不能预测血清病。使用现代纯化和经胃蛋白酶消化的马狂犬病免疫球蛋白时，过敏反应很少见。我们认为只有当出现直径>10毫米的风团（无论有无红晕）或直径5-10毫米且红晕>20毫米的风团时，皮肤试验才为阳性。需要进行长期研究来回答关于试验标准和成本效益的其余问题。
