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自我报告青霉素过敏的临床和遗传学风险

Clinical and genetic risk factors of self-reported penicillin allergy

Apter AJ, Schelleman H, Walker A 2009/5/27 10:49:52

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J Allergy Clin Immunol, 2008,

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Abstract
Background:
Patients with self-reported penicillin allergy are frequently denied β-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 (R2 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.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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