Sanz M L, García B E, Prieto I, Tabar A, Oehling A
Department of Allergology and Clinical Immunology, Faculty of Medicine, University Clinic, Pamplona, Spain.
J Investig Allergol Clin Immunol. 1996 Mar-Apr;6(2):89-93.
Allergic reactions to beta-lactams are the most frequent adverse reactions to drugs, but conventional methods of detection of beta-lactam specific IgE detect only a low number of positivities. In this study we evaluated the diagnostic reliability of one of these methods (CAP FEIA, Pharmacia) which has been proven very useful in inhalant and food specific IgE determinations. We studied specific IgE to penicillin G, penicillin V, amoxicillin and ampicillin in 1078 patients who had been diagnosed with an adverse reaction to beta-lactams, and out of this group, in a selected subgroup of 149 patients with a very suggestive clinical history of beta-lactam anaphylactic reaction. Also, positivity of specific IgE was studied in a group of 58 patients with a clinical history of immediate hypersensitivity to beta-lactams and with positive skin tests, and positivity of skin tests was studied in a subgroup of 13 patients with positive specific IgE. To increase the sensitivity of IgE determinations, we concentrated 5-fold the sera from six selected patients. In the first group we found that penicillin G specific IgE was positive in 28% of the cases when considering a cutoff > or = class 1, and 6% when considering a cutoff > or = class 2. For penicillin V, positivities were 9% (> or = class 1) and 4% (> or = class 2). In the second group, we found 31.81% sensitivity and 88.57% relative specificity of CAP FEIA with respect to the skin test. In the group of 58 patients with a clinical history of immediate hypersensitivity to beta-lactams, we found a disagreement between skin testing and specific IgE determination in 28.2%, and a positive agreement in 9.4% of the cases. After sera concentration, there was a significant increase (p < 0.001), from 0.58 to 1.61 kU/l, in beta-lactam specific IgE. Our results suggest that skin testing offers greater reliability and sensitivity than beta-lactam specific IgE determination by CAP FEIA.
对β-内酰胺类药物的过敏反应是最常见的药物不良反应，但传统的β-内酰胺特异性IgE检测方法只能检测出少数阳性病例。在本研究中，我们评估了其中一种方法（CAP FEIA，Pharmacia）的诊断可靠性，该方法已被证明在吸入性和食物特异性IgE测定中非常有用。我们研究了1078例被诊断为对β-内酰胺类药物有不良反应的患者中对青霉素G、青霉素V、阿莫西林和氨苄西林的特异性IgE，在这组患者中，还选取了149例有非常提示性β-内酰胺类过敏反应临床病史的亚组患者进行研究。此外，还研究了58例有β-内酰胺类药物速发型超敏反应临床病史且皮肤试验阳性的患者中特异性IgE的阳性情况，以及13例特异性IgE阳性患者亚组中皮肤试验的阳性情况。为了提高IgE测定的敏感性，我们对6例选定患者的血清进行了5倍浓缩。在第一组中，当临界值≥1级时，我们发现28%的病例青霉素G特异性IgE呈阳性，当临界值≥2级时为6%。对于青霉素V，阳性率分别为9%（≥1级）和4%（≥2级）。在第二组中，我们发现CAP FEIA相对于皮肤试验的敏感性为31.81%，相对特异性为88.57%。在58例有β-内酰胺类药物速发型超敏反应临床病史的患者中，我们发现皮肤试验与特异性IgE测定结果不一致的情况占28.2%，阳性一致的情况占9.4%。血清浓缩后，β-内酰胺特异性IgE显著升高（p<0.001），从0.58 kU/l升至1.61 kU/l。我们的结果表明，与通过CAP FEIA测定β-内酰胺特异性IgE相比，皮肤试验具有更高的可靠性和敏感性。
