盤尼西林過敏反應與盤尼西林皮膚測試之回顧與實務建議

A Review and Practical Advice of Penicillin Allergy and Penicillin Skin Test

邱勝康(Sheng-Kang Chiu) ； 張峰義(Feng-Yee Chang)

《內科學誌》 20卷1期 (2009/02) Pp. 58-69

https://doi.org/10.6314/JIMT.2009.20(1).08

摘要

本文旨在釐清盤尼西林皮膚測試(penicillin skin test)之價值，形成各界之共識並導正錯誤之現況。本文透過中、英文文獻之回顧與分析，針對盤尼西林過敏之學理基礎，盤尼西林皮膚測試之正確步驟，實行條件，及其限制性、安全性與法律現況予以討論。依據現行醫療資源及國外的文獻標準，建議在給予盤尼西林類藥物前，應仔細詢問病人過敏史並記載於病歷之中，若未有盤尼西林過敏反應病史，建議不需要做皮膚測試，但是在給藥中及給藥後的過程中應注意是否發生過敏反應，並準備完善的急救措施。若曾有盤尼西林過敏反應病史，該過敏非屬嚴重性，而臨床上最好的治療藥物是盤尼西林類藥物時，建議實施盤尼西林皮膚測試。台灣目前普遍的作法是針對每位需要投與盤尼西林藥物的病人先行實行皮膚測試，而國際間的指引是無過敏反應病史者不需做此項皮膚測試，因此造成了許多不需要做而做的測試；而且在台灣目前使用的試劑仍不完備尚不足以執行一個完整而正確的盤尼西林皮膚測試，亦是一項重要的問題。因此對於必要實行盤尼西林皮膚測試的對象和方法應該要有一個全面性的思考。

關鍵字

盤尼西林皮膚測試 ； 盤尼西林過敏反應

並列摘要

The aim of the article is to clarify the value of penicillin skin test and develop the consensus to correct the improper practice. By reviewing and analyzing Chinese and English literatures, the article focus on the mechanism of penicillin allergy, the correct steps to perform penicillin skin test, the indication, the limitation, the safety and the current law issues of penicillin skin test. According to current medical knowledge and the guideline of other countries, physicians should ask detail allergic history and record it on the chart before administering penicillin to a patient. If the patient did not have past history of penicillin allergy, penicillin skin test is not suggested to perform. Physicians need to be aware of the occurrence of allergic reactions and keep the available resuscitation equipment during the administration and after the administration of penicillin. If the patient had a history of penicillin allergy, which was not a severe reaction and penicillin is the best choice of treatment for the patient, the suggestion is to perform penicillin skin test to identify the risk of immediate penicillin reactions. The current medical practice in Taiwan is educated to perform this skin test on every patient who needs the use of penicillin but this practice is against international guideline. There is no available optimal reagent for penicillin skin test in Taiwan. Hence, we need a comprehensive understanding on who need the test and how to perform the test correctly.

並列關鍵字

Penicillin skin test ； Penicillin allergy