Clinical and genetic risk factors of self-reported penicillin allergy
Clinical and genetic risk factors of self-reported penicillin allergy
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DOI：
10.1016/j.jaci.2008.03.037
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发表时间：
2008-07-01
影响因子：
14.2
通讯作者：
Rebbeck, Timothy
中科院分区：
文献类型：
--
作者：
Apter, Andrea J.;Schelleman, Hedi;Rebbeck, Timothy
背景：自报青霉素过敏的患者经常被拒绝使用β-内酰胺类抗生素。目的：确定和关联自报青霉素过敏的临床和遗传危险因素。2例患者在服用青霉素后有荨麻疹、血管水肿、喘息、低血压、呕吐或过敏反应的病史。对口腔拭子中的DNA进行基因分型，检测与即刻超敏反应(IL4、IL4R和IL10)和青霉素代谢(LACTB)相关的候选基因的变异。用Logistic回归计算青霉素过敏与临床和遗传因素的关系。结果：17名过敏专科医生确定了76名成年人。有23个病例和39个对照的完整数据可用。青霉素过敏与一级亲属的青霉素过敏史(P=.002)、其他药物不良反应史(P=.008)和特应性(P=.039)相关。然而，在多变量分析中，只有青霉素过敏家族史仍然显著。IL4单核苷酸多态(SNPs)rs11740584(P=0.012)、rs10062446(P=0.021)和rs2070874(P=0.035)与青霉素过敏有关联，而LACTB SNP rs2729835(P=0.058)与青霉素过敏有一定关联。单独加入rs11740584或rs10062446改善了临床多变量模型(R-2从0.23增加到0.33)。单倍型分析没有为SNP分析提供额外的信息。结论：自我报告的青霉素过敏可能受到临床和遗传因素的影响，如IL4。
Background: Patients with self-reported penicillin allergy are frequently denied P-lactam antibiotics.Objective: To identify and correlate clinical and genetic risk factors of self-reported penicillin allergy.Methods: We conducted a case-control study of adults recruited from allergists' offices. Cases had a history of urticaria, angioedema, wheeze, hypotension, vomiting, or anaphylaxis after a dose of penicillin. DNA from buccal swabs was genotyped for variants associated with candidate genes linked to immediate hypersensitivity (IL4, IL4R, and IL10) and penicillin metabolism (LACTB). Logistic regression was used to calculate the association between penicillin allergy and clinical and genetic factors.Results: Seventeen allergists identified 76 adults. Complete data were available for 23 cases and 39 controls. Penicillin allergy was associated with a history of penicillin allergy in first-degree relatives (P =.002), a history of other adverse drug reactions (P =.008), and atopy (P =.039). However, in the multivariable analysis, only family history of penicillin allergy remained significant. IL4 single nucleotide polymorphisms (SNPs) rs11740584 (P =.012), rs10062446 (P =.021), and rs2070874 (P =.035) were associated and LACTB SNP rs2729835 (P =.058) was marginally associated with penicillin allergy. Adding rs11740584 or rs10062446 individually improved the clinical multivariable model (R-2 increased from 0.23 to 0.33). Haplotype analysis did not provide additional information to the SNP analysis.Conclusion: Self-reported penicillin allergy may be influenced by clinical and genetic factors such as IL4.