| The clinical use of penicillins was strongly limited by allergic reactions of this class of antibiotics. But there is no ideal method to detect the individual allergy to penicillins. In our country, the skin test has been used for a long time to diagnose penicillin allergy. However, there were some serious problems, such as false positive or negative reactions, and sometimes hypersensitivity can threaten patient's life. In vitro method has been used in many countries to diagnose penicillin allergy. The most widely-use and safe method is measurement of specific IgE antibodies to penicillin by different methods, of which the two most common are radioallergosorbent test (RAST) and enzyme linked immunosorbent assay (ELISA). In our laboratory, we firstly made the penicillin PLL paper discs specific to 8 kinds of penicillin antigens. Then we detected the specific IgE of patients' sera, and analyzed the relationship between skin test and specific IgE in in vitro test. Methods1. First, we linked 8 kinds of penicillin major or minor determinant PLL to the paper discs respectively, then we compared them with the paper discs contributed by Australia. We tested the fetal cord sera of 30 cases and 101 cases of healthy people sera to determine the normal range of specific IgE.Then we make the positive criterion of specific IgE in the subjects with penicillin allergy.2. Collecting sera of patients who had a history of positive skin test to penicillin, who were positive skin test immediately, and who with a negative skin test results, but having allergic symptoms when using these kinds of antibiotics. The total is259 cases.3. We detected the specific IgE of the serum by the method RAST and analyzed therelationship between the penicillin skin test and specific IgE antibodies in the seraof patients with penicillin allergy.Results1 . The study showed that the paper discs we made are safe and comparable to thosedistributed by Australia.2. The average positive rate of specific IgE antibodies was 62.2% (161/259) in the allergic patients. There was a definite relationship between skin test and serum specific IgE. The positive rates of specific IgE vs. degrees of skin test were 45.7%: "+", 57.1%:"2+", 85.2%:"3+" and 100%: "4+", respectively. And there was a significant difference among the 4 groups (P<0.05).3. The mean titers of each kinds of specific IgE in the group with a skin test positive history is lower than those in the group with positive skin test reaction immediately. Except APA-IgE and AXA-IgE, the others all have a significant statistic difference by Mest (P<0.05) .4. There are variable patterns of determinant in penicillins. In the 161 patients who had positive specific IgE, the positive rate only to one determinant is 31.7%, and it is 33.5% of cases only to one antibiotic of pencillins. These contribute to the various types of allergic response (complete cross-reaction, or partial cross-reaction, or none cross-reaction).5. The positive rate is 63% of the specific IgE antibody in the cases which have allergic reaction after administration of penicillins though the results of skin test is negative, and 62.1% in the cases with positive skin test. There is no difference between the two groups, and it is all dramatically higher than the positive rate in the normal cases that is 5% (P<0.01).6. There was no statistical difference between male and female. There was also no significant difference among different groups divided by age.7. The positive rate of specific IgE is 71.8%(51/71) in those atopic people while the positive rate is 52.6%(41/78), and there was a significant difference between thetwo groups. Conclusions1 . The penicillins determinant PLL paper discs we made were successful. It was sensitive, specific and stable.2. The positive rates about specific IgE enhance with the skin tests positive degrees elevation. The titers of specific IgE in the people with positive skin test is going down and is related to the interval' prolonging between performing skin tes...
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