Penicillin skin testing in patients with a history of β-lactam allergy
Penicillin skin testing in patients with a history of β-lactam allergy
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DOI：
10.1016/s1081-1206(10)60882-4
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发表时间：
2007-04-01
影响因子：
5.9
通讯作者：
Arroliga, Mercedes E.
中科院分区：
文献类型：
--
作者：
del Real, Gonzalo Alvarez;Rose, Mark E.;Arroliga, Mercedes E.
背景：万古霉素和氟喹诺酮类药物常用于有青霉素过敏史的患者。目的：探讨青霉素皮试（PST）的安全性和实用性。方法：对1999年4月1日至2004年9月30日有青霉素过敏史的患者进行回顾性研究。青霉素皮肤试验采用标准方法进行，使用苄青霉素酰聚氨酸、青霉素G、组胺和生理盐水作为对照。结果：596例患者中，门诊患者占25.3%，住院患者占50.3%，重症监护病房患者占24.3%。PST期间最常用的抗生素是万古霉素和氟喹诺酮类药物。88.4%的患者PST结果为阴性，8.2%为阳性，3.4%为不确定。1例患者（0.17%）在PST后立即出现荨麻疹。55%的PST阴性患者改用β -内酰胺类药物，在重症监护病房比门诊更常见（70.3%比8.6%,P < 0.001），在成人比18岁以下患者更常见（58.6%比8.1%,P < 0.001）。290例PST阴性患者使用β -内酰胺类抗生素。在接受β -内酰胺类抗生素治疗的患者中，5例（1.7%）出现不良反应：2例在治疗16天和20天后出现荨麻疹，1例在治疗17天后出现非特异性皮疹，1例在使用哌拉西林-他唑巴坦试验剂量3小时后出现潮红和荨麻疹，1例在治疗12小时后出现瘙痒性皮疹。结论：有青霉素过敏史的患者如果PST结果阴性，可以放心使用内酰胺类药物。
Background: Vancomycin and fluoroquinolones are commonly used in patients with a history of penicillin allergy.Objective: To determine the safety and utility of penicillin skin testing (PST).Methods: Retrospective study of patients with a history of penicillin allergy between April 1, 1999, and September 30, 2004. Penicillin skin testing was performed by means of standard methods using benzylpenicilloyl-polysine, penicillin G, and histamine and saline controls.Results: Of 596 patients studied, 25.3% were outpatients, 50.3% were inpatients, and 24.3% were intensive care unit patients. The most common antibiotics used during the time of PST were vancomycin and fluoroquinolones. Results of PST were negative in 88.4% of patients, positive in 8.2%, and indeterminate in 3.4%. One patient (0.17%) developed urticaria immediately after PST. Fifty-five percent of patients with negative PST results were changed to a beta-lactam drug, more frequently in the intensive care unit vs the outpatient setting (70.3% vs 8.6%; P < .001) and in adults vs patients younger than 18 years (58.6% vs 8.1%; P < .001). A beta-lactam antibiotic was used in 290 patients with negative PST results. Of the patients given beta-lactam antibiotics, 5 (1.7%) had adverse reactions: 2 had hives after 16 and 20 days of therapy, I had a nonspecific rash after 17 days of therapy, I had flushing and urticaria 3 hours after a test dose of piperacillin-tazobactam, and I had a pruritic rash after 12 hours of therapy.Conclusions: Patients with a history of penicillin allergy can safely use beta-lactam drugs if negative PST results.