| To elucidate the underlying mechanism of allergic reaction to penicillins, we explored the relationship between allergic reaction to penicillins and HLA-DRB genetic polymorphism, and the correlation between HLA-DRB genetic polymorphism and specific IgE antibodies of penicillins. Radioallergosorbent test (RAST) was used to examine 8 kinds of specific IgE antibodies of different antigenic determinants in serum (BPO-PLL, PVO-PLL, APO-PLL, AXO-PLL, BPA-PLL, PVA-PLL, APA-PLL, AXA-PLL) among 248 patients with allergic reaction to penicillins and 101 healthy subjects. 113 patients with allergic reaction to penicillins and 87 healthy subjects were choosed from all subjects to examine HLA-DRB alleles with sequence-specific primer polymerase chain reaction (PCR-SSP). 1 The relationship between allergic reaction and specific IgE antibodies1.1 The positive rate of specific IgE antibodiesThe positive rate of specific IgE antibodies in 248 patients was 57.26% (142). There was no difference between patients with allergic history and those with positive skin test. In terms of allergic symptoms, there was no difference among anaphylactic shock group, urticaria group, and other symptoms group. According to allergic reaction types, there was no difference between patients with immediate hypersensitivity reaction (IHR) and those with delayed hypersensitivity reaction(DHR). The same was true in different age groups(<18 years; 18-59 years; ≥60 years). However, the positive rate of IgE antibodiesto the male was significantly higher than that of IgE antibodies to the female (P<0.05).1.2 Allergic reaction and kinds of specific IgE antibodiesAmong 8 kinds of antigenic determinants, the positive rate of BPO-IgE antibody wasthe highest (21.37%), and the second was BPA-IgE antibody (20.56%), and that of APA-IgE antibody was the lowest (6.85%). The positive rate in patients with only one specific IgE antibody screened was 25%, but that in patients with all 8 specific IgE antibodies examined was 57.26%. The positive rate of antibodies to major antigenic determinants and minor antigenic determinants was 37.10% and 42.34% respectively, and that in patients with allergic history was 31.85% and 40% , while that in patients with positive skin test was 44.55% and 45.45%. According to allergic symptoms, the positive rate of antibodies to major antigenic determinants and minor antigenic determinants in patients with anaphylactic shock was 35.29% and 47.06% respectively, and that in patients with urticaria was 27.54% and 37.68%, whereas that in patients with other symptoms was 37.50% and 37.50%. The more varieties of antigenic determinants, the higher the positive rate of specific IgE antibodies. 1.3 Allergic crossreactivityAmong 142 patients with positive antibodies, the positive rate of BPO, PVO, APO, AXO, BPA, PVA, APA, and AXA was 7.75%, 4.23%, 2.82%, 2.82%, 7.75%, 12.68%, 0.7%, and 4.93% respectively. The results showed that 62 patients with only one kind of positive antibody accounted for 43.66% of patients with positive antibodies. Among 4 kinds of drugs, the total positive rate of IgE antibodies to PG, PV, AP and AX was 61.97%, 58.45%, 28.87%, and 45.07% respectively. The specific positive rate of IgE antibodies to PG, PV, AP and AX was 16.90%, 17.61%, 3.52% and 8.45% respectively. The results showed that partial crossreactivity existed among different kinds of penicillins. 2 The correlation between allergic reaction and genetic polymorphism 2.1 Allergic reaction and genetic polymorphismCompared with control groups, a significant increased frequency of DR9 was found in 77 patients with allergic reaction and in patients with IHR (immediate hypersensitivity reaction) (11.04% vs 4.02, P<0.05; 2.16% vs 4.02%, f<0.05), but the gene frequency of DR51 was significantly lower in patients with IHR (10.81% vs 40.23%; P<0.01). On the other hand, the gene frequency of DR17 was significantly higher in patients with DHR (delayed hypersensitivity reaction) (16.25% vs 8.05%; P<0.05), and that of DR9 and DR17 in patients with urti...
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