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评估和管理青素过敏:一篇评论
Erica S Shenoy1,2,3, Eric Macy4, Theresa Rowe5
1Harvard Medical School, Boston, Massachusetts.
JAMA
|January 16, 2019
概括
许多患者报告过敏, 但很少有真正的过敏. 评估报告的青素过敏对于抗菌药物管理和预防耐药性至关重要.
科学领域:
- 临床医学
- 传染性疾病
- 药理学
背景情况:
- 乙乳酸抗生素是安全有效的,但报告的过敏症限制了它们的使用.
- 据报道,青素过敏影响了约10%的美国人口,导致广泛使用抗生素.
- 宽谱抗生素增加了抗菌耐药性和C. difficile感染等不良事件的风险.
研究的目的:
- 评估报告的青素过敏的临床意义.
- 评估青素过敏评估在抗菌管理中的作用.
- 根据过敏风险分层指导适当的抗生素选择.
主要方法:
- 检查患者病史以对青素过敏风险进行分类 (低,中等,高).
- 评估IgE介导和T淋巴细胞介导的过敏症.
- 对中度风险患者的直接阿莫西林挑战和青素皮肤测试的评估.
主要成果:
- 临床显著的青素过敏不常见 (< 5% 的报道过敏).
- 随着时间的推移,IgE介导的青素过敏会减弱;80%的人在十年内会对青素产生耐受性.
- 素皮肤试验与阿莫西林挑战结合显示高负预测值 (> 95%).
结论:
- 大多数报告患有青素过敏的患者没有临床显著的过敏.
- 对青素过敏的评估是抗菌药物管理的重要工具.
- 准确的过敏评估使得β-乳酸抗生素的适当使用成为可能,减少对广谱药物的依赖.
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