Background

Immediate hypersensitivity reactions to penicillins are often labeled on the basis of a similar set of symptoms, but a key feature of these reactions that can be reproduced in diagnostic testing may be the timing of a reaction in relation to the dose administration.

Objective

To determine whether the timing of a reaction in response to the last dose of a penicillin would predict the results of diagnostic testing.

Methods

We evaluated 1074 patients by performing skin tests, serum specific IgE assays (ImmunoCAP), and challenges. Patients who were evaluated by us more than 6 months after their reactions and found negative were reevaluated within 2 to 4 weeks.

Results

Patients who had reacted within 1 hour after the first dose, within 1 hour after subsequent doses, more than 1 hour to within 6 hours after the first dose, or more than 1 hour to within 6 hours after subsequent doses were classified as group A (758 individuals), B (92), C (67), or D (157), respectively. Penicillin hypersensitivity was diagnosed in 707 patients (65.8%) by skin tests (407 patients, 57.6%), ImmunoCAP (47, 6.6%), both tests (232, 32.8%), or challenges (21, 3%). A conversion to allergy-test positivity occurred in 7 of 10 patients with anaphylactic reactions and in 1 of 28 patients with other reactions who were reevaluated after negative challenges. The rate of penicillin-allergic patients in groups A, B, C, and D was 85%, 35.9%, 35.8%, and 3.8%, respectively. Only 1 of 107 patients reporting cutaneous reactions lasting more than 1 day had positive results to allergy tests.

Conclusions

IgE-mediated hypersensitivity can be diagnosed by skin tests in about 70% of subjects who react within 1 hour (eg, patients from groups A and B). This hypersensitivity can be lost over time, as demonstrated by the negativization of allergy tests in follow-up studies. In subjects with anaphylactic reactions, however, it is advisable to not consider this phenomenon definitive. In fact, a conversion to allergy test positivity can be observed in up to 20% of such subjects retested after negative challenges.

中文翻译：

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时间顺序和形态标准在即时青霉素反应评估中的结合使用：来自大型研究的证据

背景

对青霉素的速发型超敏反应通常根据一组相似的症状进行标记，但可以在诊断测试中重现的这些反应的一个关键特征可能是与给药剂量相关的反应时间。

客观的

确定对最后一剂青霉素的反应时间是否可以预测诊断测试的结果。

方法

我们通过进行皮肤测试、血清特异性 IgE 检测 (ImmunoCAP) 和挑战对 1074 名患者进行了评估。在反应发生后超过 6 个月由我们评估并发现阴性的患者在 2 至 4 周内重新评估。

结果

首次给药后 1 小时内、后续给药后 1 小时内、首次给药后 1 小时以上至 6 小时内或后续给药后 1 小时以上至 6 小时内发生反应的患者被归类为 A 组（ 758 人）、B（92）、C（67）或 D（157）。707 名患者 (65.8%) 通过皮肤试验（407 名患者，57.6%）、 ImmunoCAP（47 名患者，6.6%）、两项试验（232 名患者，32.8%）或激发试验（21 名患者，3%）诊断出青霉素超敏反应。10 名发生过敏反应的患者中有 7 名转变为过敏测试阳性在 28 名有其他反应的患者中，有 1 名在负面挑战后重新评估。A、B、C、D组青霉素过敏患者比例分别为85%、35.9%、35.8%、3.8%。报告皮肤反应持续超过 1 天的 107 名患者中只有 1 名过敏测试结果呈阳性。

结论

IgE 介导的超敏反应可以通过在 1 小时内发生反应的约 70% 的受试者（例如，来自 A 组和 B 组的患者）的皮肤试验来诊断。这种超敏反应会随着时间的推移而消失，正如后续研究中过敏测试的阴性结果所证明的那样。然而，对于有过敏反应的受试者，建议不要将这种现象视为确定性的。事实上，可以在多达 20% 的此类受试者中观察到在负面挑战后重新测试的过敏测试阳性的转换。