“青霉素过敏史”主诉患者规范化青霉素过敏检测结果  

Clinical outcomes following standardized allergic testing in patients with self-reported penicillin allergy

作　　者：肖浩[1] 张虹婷[1] 孟娟[1] XIAO Hao;ZHANG Hong-ting;MENG Juan(Allergy Center of West China Hospital,Sichuan University,Chengdu 610041)

机构地区：[1]四川大学华西医院过敏性疾病诊治中心,成都610041

出　　处：《中华临床免疫和变态反应杂志》2021年第4期390-397,共8页Chinese Journal of Allergy & Clinical Immunology

基　　金：四川大学华西医院学科卓越发展1·3·5工程临床研究孵化项目(2018HXFH026)。

摘　　要：目的通过对“青霉素过敏史”主诉患者进行规范化青霉素过敏检测,初步了解我国青霉素过敏现状及特点。方法总结分析2019年9月至2020年8月,因“青霉素过敏史”主诉在华西医院过敏性疾病诊治中心进行规范化青霉素过敏检测患者的临床数据。结果共纳入32例患者,既往青霉素给药前常规皮试阳性者17例(53.1%),使用青霉素后出现“过敏”症状者15例(46.9%)。最终经规范化检测确诊青霉素过敏5例(15.6%),其中3例(60%)根据规范化皮肤试验阳性结果确诊,2例(40%)经激发试验确诊。既往常规青霉素皮试阳性的17例患者中,仅1例(5.9%)确诊过敏,其青霉噻唑酰多聚赖氨酸(penicilloyl-poly-lysine,PPL)、青霉素G、阿莫西林皮肤点刺试验(skin prick test,SPT)阳性。使用青霉素后出现“过敏”症状的15例患者中,4例(26.7%)确诊过敏,其中2例皮内试验阳性[1例PPL及次要抗原决定簇(minor determinant,MD)阳性,另外1例MD阳性],2例激发试验阳性。青霉素过敏确诊组和排除组患者临床特征,包括性别、年龄、过敏性疾病史、可疑致敏青霉素是否明确均无统计学差异(P>0.05)。既往有严重过敏反应史者在青霉素过敏确诊组(40%)中最为常见;给药前常规青霉素皮试阳性是青霉素过敏排除组(59.3%)最常见的主诉。结论有“青霉素过敏史”主诉患者,最终仅15.6%患者确诊过敏。本研究初步提示青霉素给药前常规皮试,一方面假阳性率高达94.1%,会造成大量患者被误诊为青霉素过敏;另一方面亦会造成真正过敏患者被漏诊。Objective To investigate current status of penicillin allergy(PA)in China primarily.Methods Clinical data of patients were summarized and analyzed,who were with self-reported of PA and finished standardized PA tests in Allergy Center of West China Hospital,Sichuan University from September 2019 to August 2020.Results Totally 32 patients were included in this study.17 of them(53.1%)had chief complaints of PA due to previous positive results of routine penicillin skin test(RPST)before administration,another 15 patients(46.9%)with chief complaints of“allergic symptoms”after administration.Diagnosis of PA were confirmed among 5 patients(15.6%),3 of them basing on positive results of standard skin test and another 2 patients basing on positive results of challenge test.Among 17 patients with previous positive results of RPST,diagnosis of PA was confirmed only in one patient(5.9%),basing on positive result of skin prick test(SPT)to penicilloyl-poly-lysine(PPL),penicillin G and amoxicillin.Among another 15 cases with chief complaints of“allergic symptoms”after administrations,diagnosis of PA was confirmed in 4(26.7%)patients,2 basing on positive results of intradermal tests(one was positive to PPL and minor determinant(MD),another was positive to MD),2 basing on positive results of challenge tests.There was no significant difference statistically in clinical characteristics between confirmed and excluded diagnosis group,including gender,age,history of allergic diseases and culprits of penicillin(P>0.05).History of anaphylaxis(40%)was more common in diagnosis-confirmed group,while positive results of RPST(59.3%)predominated in diagnosis-excluded group.Conclusion Diagnosis of PA only could be confirmed among 15.6%of patients with self-reported PA,The false positive rate of RPST was as high as 94.1%,resulted in numerous misdiagnosis of PA.In another hand,it also led to misdiagnosis of genuine penicillin allergy.

关 键 词：青霉素过敏 皮试 主要抗原决定簇 次要抗原决定簇 激发试验 

分 类 号：R59[医药卫生—内科学]