■妊娠梅毒未被诊断和治疗不足,导致死产,早产,低出生体重,新生儿死亡,和先天性梅毒。大多数标记为对青霉素过敏的患者被误诊。
■评估一种算法的有效性和安全性,以指导梅毒孕妇再次接触青霉素并报告对抗生素过敏。
我们进行了一项前瞻性研究,评估患有梅毒并标记为对青霉素过敏的孕妇。根据临床病史,患者分为两组:青霉素过敏高危和低危.皮肤试验阴性和青霉素血清特异性IgE阴性的低风险患者接受了药物激发试验。其余患者接受脱敏。
■纳入91例患者。在7.69%的梅毒孕妇中确认了青霉素过敏,并且有青霉素过敏的临床病史;在所有情况下,通过皮内测试进行诊断,这预测了在快速药物脱敏过程中观察到的100%的突破反应(p<0.001)。根据最初的临床反应和皮肤测试进行风险分层,以指导通过药物攻击或脱敏重新引入青霉素是安全的(97.8%)和有效的(97.8%)。
■我们开发并显示了一种算法的有效性和安全性,该算法可指导梅毒孕妇再次接触青霉素并标记为对该药物过敏。皮内试验是诊断对青霉素的即时超敏反应和预测药物快速脱敏过程中的突破反应的良好生物标志物。进一步的研究可以证实与口服方案相比,静脉内方案的安全性更高。
UNASSIGNED: Gestational syphilis is underdiagnosed and undertreated, leading to stillbirth, prematurity, low birthweight, neonatal death, and congenital syphilis. Most patients who label as allergic to penicillin are misdiagnosed.
UNASSIGNED: To assess the efficacy and safety of an algorithm to guide re-exposure to penicillin in pregnant women with syphilis and reporting allergy to the antibiotic.
UNASSIGNED: We performed a prospective study assessing pregnant women with syphilis and labeled as allergic to penicillin. Based on clinical history, patients were divided in two groups: high-risk and low-risk to penicillin allergy. Low-risk patients with negative skin testing and negative serum specific IgE to penicillin underwent drug provocation test. The remaining patients underwent desensitization.
UNASSIGNED: Ninety-one patients were enrolled. Allergy to penicillin was confirmed in 7.69% of pregnant women with syphilis and clinical history of allergy to penicillin; in all cases the diagnosis was made through intradermal testing, which predicted 100% of the breakthrough reactions observed during rapid drug desensitization (p < 0.001). Risk stratification based on the initial clinical reaction and skin testing to guide penicillin re-introduction through drug challenge or desensitization was safe (97.8%) and effective (97.8%).
UNASSIGNED: We developed and showed the efficacy and safety of an algorithm to guide re-exposure to penicillin in pregnant women with syphilis and labeled as allergic to this drug. Intradermal test is an excellent biomarker in the diagnosis of immediate hypersensitivity reaction to penicillin and to predict breakthrough reaction during rapid drug desensitization. Further studies may confirm the greater safety of the intravenous protocol compared to the oral protocol.