体内外联合试验检测青霉素特异性多克隆淋巴细胞活性特征:青霉素的安全耐受性试验而非药物致死性试验

作     者：Sachs B. Al Masaoudi T. Merk H.F. Erdmann S. 崔荣 

作者机构：Dept. of Dermatol ogy and Allergology Rheinisch-Westf. Tech. Hochsch. A. Pauwelsstrafle 30 52 074 AachenGermany Dr. 

出 版 物：《世界核心医学期刊文摘（皮肤病学分册）》 (Digest of the World Core Medical JOurnals:Dermatology)

年 卷 期：2005年第1卷第3期

页      面：53-53页

学科分类：1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 100215[医学-康复医学与理疗学] 10[医学] 

主　　题：联合试验 特异性 淋巴细胞反应 皮内试验 迟发性超敏反应 斑贴试验 迟发性反应 体外试验 体内外试验 体内试验 

摘      要：Background: Amino-penicillins are a major cause of delayedtype reactions to penicillins. Objectives The aim of this study was to establish a diagnostic app roach for the characterization of the individual penicillin-specific polyclona l lymphocyte reactivity in order to detect side chain-specific sensitization t o amino-penicillins. Patients can then be advised to undergo a tolerance test with safe penicillins instead of provocation with culprit penicillins for confir mation of penicillin allergy. Methods: We investigated penicillin-specific pol yclonal lymphocyte reactivity in nine patients with delayed-type reactions to amino-penicillins by a combined in vivo (patch, prick and intracutaneous tests with delayed readings) and in vitro (lym-phocyte transformation test, LTT) ap proach. Results: A combination of LTT and skin tests improved the sensitivity fo r the characterization of penicillin-specific polyclonal lymphocyte reactivity and allowed the detection of three different patterns of lymphocyte reactivity. Four patients showed a side chain-specific sensitization to amino-penicilli ns in vivo and in vitro and were advised to undergo tolerance tests with safe pe nicillins. Two patients agreed and were exposed to parenteral benzyl-penicilli n and oral phenoxymethyl-penicillin which they tolerated without complications . Conclusions: These data suggest that a combined in vivo and in vitro approach is helpful for the detection of side chain-specific sensitization to aminopeni cillins. Patients with such sensitization are very likely to tolerate safe penic illins, thereby expanding their therapeutic options when antibiotic treatment is required.