세팔로스포린계 항생제에 대한 Skin Test 현황 분석

박지은,황서영,이용석,이후경,이영미 한국병원약사회 2013 병원약사회지 Vol.30 No.4

Although allergic reactions to cephalosporins have been estimated to be infrequent,these agents can induce severe or life-threatening IgE-mediated reactions for some cases. Unlike penicillin, cephalosporin haptens and determinants have not yet been fylly identified. Therefore, usually the whole antibiotics are usually used as skin test reagents, diluted at nonirritating concentration in attempts to detect the presence of IgE antibodies to cephalosporins. Skin testing with the reagents above has not yet been proven to be reliable for predicting hypersensitivity reactions. Thus, the usefulness of skin testing before administration of the drugs is controversial. In Samsung Medical Center (SMC), skin tests have been generally performed before administrating the cephalosporins. Therefore, this study is aimed to investigate current statuses of cephalosporin skin testing and supplementary clinical evidences. From May 1 to May 18, 2012, 1462 cases of cephalosporin skin tests, performed at inpatient setting were included and electronic medical records (EMR) of them were retrospectively reviewed. 13 injected cephalosporins were involved. Cephalosporin-induced reactions were distinguished based on three causality assessment criteria, and IgE-mediated reactions were defined as reactions developed within 72 hours after administration of the drugs. Among the total of 1462 skin tests performed, 21 cases were reported to be skin test positive and 1441 cases were reported to be skin test negative. In 21 cases of positive skin tests, all the patients didn't receive cephalosporins according to the skin test guidelines in SMC. Among skin test negative cases, the patients were challenged with the drugs in only 1413 cases. And it was found that 32 (2.26%) of them presented possible IgE-mediated reactions despite the negative skin test results. Symptoms of IgE-mediated reactions were usually mild and self-limited or subsided promptly without stopping administration of the drugs; no cases of life-threatening anaphylactic reactions had occurred. Only in 5 cases, cephalosporins were being discontinued for treating allergic reactions, and 2 (0.14%) of them were assessed to be specifically highly probable. In conclusion, the present study described the prevalence of cephalosporin skin test results and suggested the incidence of false negative reactions in skin test-negative group. Unfortunately, we could not obtain the information on false positive reactions in the skin test-positive group. If it was feasible to administer drugs after positive skin tests and follow up on whether the hypersensitivity reactions really occur, additional conclusions could be derived. However, in respect of patient's consents, it may still be difficult to administer drugs in those patients. Therefore, at this point of time skin tests have been performed routinely, the reported data would help to enhance the less known clinical information on cephalosporin skin tests.

소아 급성림프구성백혈병 치료에서 L-asparaginase의skin test 시행 방법의 적절성 평가

김경덕,박애령,김순주,황보신이,나현오 한국병원약사회 2018 병원약사회지 Vol.35 No.1

Background and Objective : L-asparaginase is the chemotherapeutic agent for the treatment of acute lymphoblastic leukemia and is associated with hypersensitivity reactions. Because of the high rates of hypersensitivity reactions, skin test has been proposed. However, the method of skin test not standardized, and false-positive and false-negative results have been documented. We have conducted skin tests prior to every dose of L-asparaginase. In consideration of the convenience of administration, the skin test is changed to be conducted prior to the first dose of L-asparaginase and prior to restarting therapy after an interval of a week or more has elapsed between doses by intervention of a pediatric oncology pharmacist. The objective of this study was to evaluate the sensitivity and specificity of skin tests. Methods : From July-December 2012, patients that received skin tests prior to every dose of Lasparaginase were classified A group. From July-December 2013, patients that received skin tests prior to the first dose of L-asparaginase and prior to restarting therapy after an interval of a week or more has elapsed between doses were classified B group. Results : 63 patients were included in the A group and received 402 cases of skin tests. 65 patients were included in the B group and received 126 cases of skin tests. The sensitivity of skin tests in the B group (52.2%) was superior to the A group (20%). This result showed statistically significant difference (p=0.047). The specificity of skin tests in the A group (96.1%) was superior to the B group (90.3%). This result showed statistically significant difference (p=0.017). Conclusion : In conclusion, reducing the number of skin tests by intervention of a pediatric oncology pharmacist improved convenience of administration and enhanced clinical safety of chemotherapy.

International regulatory requirements for skin sensitization testing

Daniel, Amber B.,Strickland, Judy,Allen, David,Casati, Silvia,Zuang, Valé,rie,Barroso, Joã,o,Whelan, Maurice,Ré,gimbald-Krnel, M.J.,Kojima, Hajime,Nishikawa, Akiyoshi,Park, Hye-Kyung Elsevier 2018 Regulatory toxicology and pharmacology Vol.95 No.-

<P><B>Abstract</B></P> <P>Skin sensitization test data are required or considered by chemical regulation authorities around the world. These data are used to develop product hazard labeling for the protection of consumers or workers and to assess risks from exposure to skin-sensitizing chemicals. To identify opportunities for regulatory uses of non-animal replacements for skin sensitization tests, the needs and uses for skin sensitization test data must first be clarified. Thus, we reviewed skin sensitization testing requirements for seven countries or regions that are represented in the International Cooperation on Alternative Test Methods (ICATM). We noted the type of skin sensitization data required for each chemical sector and whether these data were used in a hazard classification, potency classification, or risk assessment context; the preferred tests; and whether alternative non-animal tests were acceptable. An understanding of national and regional regulatory requirements for skin sensitization testing will inform the development of ICATM's international strategy for the acceptance and implementation of non-animal alternatives to assess the health hazards and risks associated with potential skin sensitizers.</P> <P><B>Highlights</B></P> <P> <UL> <LI> We reviewed regulatory requirements for skin sensitization testing, by chemical sector, of seven countries or regions. </LI> <LI> This review summarizes data needs for hazard classification, potency classification, and risk assessment. </LI> <LI> We identify preferred test methods and note whether non-animal alternative test methods are acceptable. </LI> <LI> This effort will inform an international strategy for implementing non-animal approaches for skin sensitization assessment. </LI> </UL> </P>

만성 자발성 두드러기 환자에서 자가혈청 피부반응검사에 따른 검사실 소견과 증상 조절을 위한 약제의 비교

이수경 ( Su Kyoung Lee ),조민호 ( Min Ho Cho ),김병연 ( Byeong Yeon Kim ),강윤성 ( Yun Sung Kang ),최승헌 ( Seung Heon Choi ),손성욱 ( Seong Wook Sohn ) 대한천식알레르기학회 2012 천식 및 알레르기 Vol.32 No.4

Background: The autologous serum skin test is reported to be positive in up to 60% of patients with chronic spontaneous urticaria. However, the clinical role of autologous serum skin test is still poorly understood. Methods: We reviewed the medical records of 166 chronic spontaneous urticaria patients whose symptoms lasted for more than 6 weeks and compared their laboratory findings and medication levels according to autologous serum skin test reactivity. Results: Autologous serum skin test was positive in 69 (41.6%) chronic spontaneous urticaria patients. There were no significant differences between autologous serum skin test-positive and autologous serum skin test-negative groups in laboratory findings, such as anti-microsome antibody, anti- thyroglobulin antibody, anti-nuclear antibody, total immunoglobulin E, complement 4 level levels, rheumatoid factor, erythrocyte sedimentation rate and D-dimer. Autologous serum skin test were not related to medication levels. Eight patients (11.6%) of autologous serum skin test-positive groups and 6 patients (6.2%) of autologous serum skin test-negative groups need level 4 medication (usage of cyclosporine, dapsone or anti-immunoglobulin E monoclonal antibody) to control urticaria without statistical significance. Conclusion: Autologous serum skin test was positive in more than 40% of chronic spontaneous urticaria patients. However, laboratory findings and medication levels were not affected by autologous serum skin test reactivity.

요오드화 조영제 과민반응 예측을 위한 사전 피부 시험의 유효성

김태범 대한의사협회 2020 대한의사협회지 Vol.63 No.3

Hypersensitivity reaction to iodinated contrast media (ICM) is a persistent clinical issue owing to widespread use of computed tomography (CT) examinations. The question of whether routine performance of skin tests can predict hypersensitivity reactions to contrast media remains unresolved. Recently, a prospective study was performed to evaluate the role of an intradermal skin test as a prescreening test for hypersensitivity reactions to ICM. Fifteen (0.5%) of the 2,843 patients had positive skin test results prior to scheduled CT scans. However, none of the patients experienced a hypersensitivity reaction after administration of full-dose ICM. Meanwhile, 19 patients who experienced hypersensitivity reactions to an ICM challenge showed negative skin test results. The sensitivity and positive predictive value of skin tests for hypersensitivity reaction to ICM were both 0%. More studies should be conducted to confirm the uselessness of prescreening skin tests. In conclusion, a prescreening intradermal skin test prior to a CT scan has no significant clinical value as a tool for predicting hypersensitivity reactions to ICM. Therefore, prescreening skin tests should not be routinely performed.

Results of Intradermal Skin Testing with Cefazolin according to a History of Hypersensitivity to Antibiotics

권재우,김윤정,양민석,송우정,김세훈,조상헌,장윤석 대한의학회 2019 Journal of Korean medical science Vol.34 No.50

Background: The relationship between cephalosporin hypersensitivity and a history of β-lactam hypersensitivity is unclear. We evaluated the usefulness of routine intradermal cefazolin skin testing and its relationship with the history of β-lactam hypersensitivity. Methods: The electronic medical records of patients who underwent intradermal cefazolin (0.3 mg/mL) skin testing without negative controls from January 2010 to January 2011 at Seoul National University Bundang Hospital were evaluated. The history of β-lactam hypersensitivity of the patients was taken. Immediate adverse reactions after cefazolin injection were evaluated by searching the electronic medical records for key words and reviewing consultation documents of allergy specialists or dermatologists. The medical records of the patients were reviewed by an allergist. Results: There were 13,153 cases of cefazolin skin testing over the 13-month study period. Among the 12,969 cases with negative skin test results, 8 had immediate hypersensitivity related to cefazolin (0.06%). The negative predictive value of cefazolin skin testing alone wa 99.94%. The overall positivity rate of cefazolin skin tests was 1.4% (184/13,153). Of the cases with a history of allergy to β-lactams, 15% (6/40) showed a positive cefazolin skin test result compared to only 1.36% (178/13,113) of cases with no such history (P < 0.001) including som false-positive tests. Conclusion: The results suggest that routine screening involving cefazolin skin testing without negative controls is not useful for all patients, but could be helpful for those with a history of β-lactam hypersensitivity, although a large prospective study is needed to confirm this.

BV와 BVP의 Skin Test 국소반응에 대한 연구

신민섭,신진철,이부영,육태한,Shin, Min-Seop,Shin, Jin-Cheol,Lee, Bu-Young,Yuk, Tae-Han 대한약침학회 2006 Journal of pharmacopuncture Vol.9 No.1

Objective : The purpose of the study was to observe local reactions of BV and BVP skin test, and to compare those between BV and BVP. Methods : We performed BV or BVP Skin test to 42 patients, and then we measured wheal and erytherma on skin test area by digital caliper after 15 minutes. Results : 1. In BV Skin test, the mean size of wheals was $l0.l0{\pm}0.78mm$ and the mean size of erythermas was $29.85{\pm}6.23mm$. 2. In BVP Skin test, the mean size of wheals was $7.05{\pm}3.20mm$ and the mean size of erythermas was $19.58{\pm}7.62mm$. 3. The local reactions of BVP Skin test decreased significantly(P<0.01) than those of BV skin test.

알레르기비염 환자에서 집먼지진드기와 쑥화분에 대한 MAST, 피부단자시험 및 비유발시험 간의 연관성에 관한 연구

장태영 ( Tae Young Jang ),최윤석 ( Yoon Seok Choi ),김경태 ( Kyung Tae Kim ) 대한천식알레르기학회 2004 천식 및 알레르기 Vol.24 No.1

아토피 환자에서 Pharmacia CAP 시스템 검사법과 Auro,Dex(R) Visual,ENSTM 선별 검사법을 이용한 특이 IgE 항체 측정 결과 비교

곽이경 ( Yee Gyung Kwak ),맹선희 ( Sun Hee Maeng ),김희선 ( Hee Sun Kim ),조영주 ( Young Joo Cho ) 대한천식알레르기학회 2003 천식 및 알레르기 Vol.23 No.1

민감성 피부에서 젖산 자상 검사 및 기초경표피수분손실에 대한 연구

김진영 ( Jin Young Kim ),김상석 ( Sang Seok Kim ),조희진 ( Hee Jin Cho ),박천욱 ( Chun Wook Park ),이철헌 ( Cheol Heon Lee ) 대한피부과학회 2006 대한피부과학회지 Vol.44 No.5

Background: Patients with sensitive skin are those individuals who state that their skin is more sensitive than the average person. But there is no clear-cut dermatological definition to describe, or standard method to evaluate sensitive skin. Objective: To elucidate the biophysical differences between sensitive and non-sensitive skins, we measured baseline transepidermal water loss (TEWL) and performed the lactic acid sting test. Methods: A total of 503 people responded to self-assessment questionnaires, composed of questions about self-perception, related factors, and symptoms and signs of sensitive skin. In 55 of these, we measured baseline TEWL and performed a 10% lactic acid sting test on the malar eminence of the face using a Hilltop chamber. In the lactic acid sting test, the stinging sensation was rated by patients every 1 minute, on a 4-point scale, with cumulative stinging scores. Results: The incidence of self-reported sensitive skin was 43.3% for women and 23.9% for men. The cumulative scores of the lactic acid sting test were not higher in the sensitive skin group (p>0.05). However, the onset time of the stinging sensation was faster in the sensitive skin group (p<0.05). There was no difference in the baseline TEWL (p>0.05) between the sensitive skin and non-sensitive skin groups. Furthermore there was no correlation between baseline TEWL and 10% lactic acid sting test in the sensitive skin group compared to the non-sensitive skin group (p>0.05). Conclusion: Our experiment showed that the 10% lactic acid sting test is still not an adequate or ideal method to assess sensitive skin, and another new reproducible and objective method is necessary to assess sensitive skin. (Korean J Dermatol 2006;44(5):561~566)