Aminopenicillin-associated exanthem: lymphocyte transformation testing revisited
Aminopenicillin-associated exanthem: lymphocyte transformation testing revisited
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DOI：
10.1111/cea.12437
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发表时间：
2014-12-01
影响因子：
6.1
通讯作者：
Kerstan, A.
中科院分区：
文献类型：
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作者：
Trautmann, A.;Seitz, C. S.;Kerstan, A.
背景淋巴细胞转化试验（LTT）已被推广为药物过敏的体外诊断试验。为了确定统计学LTT敏感性，必须对具有临床一致反应的患者系列进行完整的药物超敏反应检查。LTT特异性的评估需要控制患者谁耐受暴露于药物studied. Objectives前瞻性地确定在临床和诊断明确的系列patients.MethodsPatients与暴露性皮疹氨苄青霉素（AMP）摄入后的LTT的诊断价值包括在本研究中。后排除或确认迟发型过敏性AMP超敏反应的皮肤和激发试验，两个独立的LTT进行：一个标准的LTT和修改的LTT与额外的抗-CD 3/抗-CD 28单克隆抗体stimulation.ResultsBy测试，迟发型过敏性AMP超敏反应被诊断为11例，并明确排除在26。标准LTT的诊断灵敏度为54.5%，而改良LTT的诊断灵敏度为72.7%。然而，方法学试验的改进导致特异性从92.3%（标准LTT）下降到76.9%。结论和临床意义在AMP相关性黄嘌呤的病例中，LTT与常规过敏试验相比的诊断价值有限。在评估这些exanthems时，激发试验仍然是金标准。延迟皮内皮试的阅读对于避免阳性激发反应仍然是最有用的。
BackgroundThe lymphocyte transformation test (LTT) has been promoted as in-vitro test for diagnosis of drug hypersensitivity. For determination of statistical LTT sensitivity, series of patients with clinically uniform reactions followed by complete drug hypersensitivity work-up are mandatory. Assessment of LTT specificity requires control patients who tolerated exposure to the drug studied.ObjectiveTo prospectively determine the diagnostic value of the LTT in a clinically and diagnostically well-defined series of patients.MethodsPatients with exanthematous skin eruptions after ampicillin (AMP) intake were included in this study. After exclusion or confirmation of delayed-onset allergic AMP hypersensitivity by skin and provocation testing, two independent LTTs were performed: one standard LTT and a modified LTT with additional anti-CD3/anti-CD28 monoclonal antibody stimulation.ResultsBy testing, delayed-onset allergic AMP hypersensitivity was diagnosed in 11 patients and definitely ruled out in 26. The standard LTT reached a diagnostic sensitivity of 54.5% while the modified LTT yielded 72.7%. However, the methodical test modification resulted in a decline of specificity from 92.3% (standard LTT) to 76.9%.Conclusions and Clinical RelevanceIn cases of AMP-associated exanthems, the diagnostic value of the LTT compared with routine allergy testing is limited. When evaluating such exanthems, provocation testing remains the gold standard. Delayed reading of intradermal skin tests remains most useful to avoid positive provocation reactions.