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The upward trend in recent years, with the increase in abuse cephalosporin antibiotics in clinical use, the incidence of allergic reactions. Recent studies suggest that cross allergic reaction between the β-lactam antibiotics should be mainly attributed to its similar structure of the side chain, while the role of the R1 side chain structure in the cross-allergic reactions in the two types of drugs to be further studied. This study intends to study patients allergic to β-lactam antibiotics, to further explore the penicillin class of antibiotics and cephalosporin antibiotics allergic reaction mechanisms, the status of the the evaluation side chain structure in the cross-allergic reactions. Methods radioactive allergen assay (RAST) specific IgE antibodies were detected 420 cases of penicillin antibiotic allergy patients and 80 normal subjects and 34 patients with cephalosporin antibiotics allergy patients and 87 patients with normal human body penicillins (BPO, PVO, APO, AXO, BPA, PVA, APA, AXA), as well as 11 kinds of cephalosporins specific IgE antibodies (CEXO, CLO, CEZO, CPZO, CTO, CZO, CXO, CEXA, CLA, CEZA, CPZA ), RAST inhibition test of the four cases of the typical allergic patients 4 penicillin antibiotic (BP, PV, AP, AX), 7 kinds of cephalosporin antibiotics (CEX, CL, CEZ, CPZ, CT, CZ, CX) and two kinds of mother nucleus structure (6-APA ,7-ACA), 4 of side chain structure (PHA, PHOA, NPG, PHPG) inhibition rate. Results 1. Allergic patients serum specific IgE antibody 1.1 allergic reactions in allergy cases with 454 cases of specific IgE antibodies in addition to CPZO-IgE antibodies and other 18 kinds of specific IgE antibodies water were higher than those in the control group (P lt; 0.05 ). BPO-IgE antibodies in penicillin-specific IgE antibodies in the highest positive rate was 28.63%, the lowest rate of APA-IgE antibodies, only 8.81%; specific IgE antibodies in cephalosporins CPZA-IgE anti examination the highest positive rate was 8.15%, the lowest CPZO-IgE antibody positive rate of only 2.64%. Wherein, the 420 patients with penicillin antibiotic allergic patients, 291 patients (69.29%) of at least one β-lactam-specific IgE antibody-positive, 269 patients (64.05%) of at least one penicillin-specific IgE antibody-positive, 95 cases (22.62%) were positive specific IgE antibodies to at least one of cephalosporins; 34 cases of cephalosporin antibiotics allergy patients, 33 cases (97.06%) at least one β-lactam specific IgE antibodies positive, 19 cases (55.88%), at least one of the penicillin-specific IgE antibodies were positive, 32 cases (94.12%) were positive specific IgE antibodies to at least one of cephalosporins. The results showed that allergic to cephalosporins cephalosporins specific IgE antibody positive rate and the β-lactam class IgE antibody positive rate was significantly higher than patients with allergy to penicillin antibiotics (P lt; 0.01) in the patient's serum, two types of penicillin allergic patients specific IgE antibodies was no significant difference (P gt; 0.05). The 1.2 skin test, symptoms of an allergic reaction, allergic reaction type, gender and IgE antibodies to 454 cases of allergic patients the results of the skin test is divided into a positive skin test (307 cases) and skin test negative groups (n = 147), divided by gender men (264 cases) and women (190 cases) groups; 147 cases of patients with a history of allergies, allergic reaction symptoms divided into anaphylactic shock (29 cases), urticaria (74 cases) and other symptoms (44 cases ) three groups, according to an allergic reaction type will be divided into immediate (77 cases) and delayed (70 cases) groups. Although there are several specific IgE antibody levels in the presence of the differences between the two groups (P lt; 0.05), β-lactam penicillin, cephalosporin three types of specific IgE antibody positive rate in the group had no significant difference (P gt.; 0.05). 1.3 epitopes cluster types with specific IgE antibody positive rate of detection of beta-lactam-specific IgE antibody positive rate was 28.64% (108 cases); detection of 19 beta-lactam-specific IgE antibodies, positive rate was 71.37% (324 cases). The results show that the detected type of antigen the 1-8 species specific IgE antibody positive rate with the number of the detected antigen epitope species was significantly increased (P LT 9 or more kinds; 0.05) showed no significant difference ( P gt; 0.05). Visible, specific IgE antibody positive rate with the type of antigen detection increased saturation. 2. Penicillin antibiotics and cephalosporins cross allergic reactions 2.1 Total cross-allergic reaction to the case of 454 cases of allergic patients, 90 cases (19.82%) in the presence of penicillin and cephalosporin antibiotics cross allergic reactions. Spearman correlation analysis found, APA-IgE the AXA-IgE, APA-the IgE and CEXA-IgE the AXA-IgE and CEXA-IgE epitope specific IgE antibodies to minor antigens have the same or similar side chain structure of antibiotics BPA-IgE, CLA-IgE were positively correlated (P lt; 0.05), cephalexin and ampicillin, amoxicillin antibody positive group antibody positive rate was significantly higher than the antibody-negative group (P lt; 0.05), and penicillin G Cephalothin antibody positive rate of antibody positive and negative groups showed no significant difference (P gt; 0.05). 2.2 penicillin antibiotic allergy patients penicillin antibiotics and cephalosporins cross in 73 cases (17.38%) of 420 cases of allergy to penicillin allergic patients penicillins and cephalosporins cross allergic reactions, 95 cases ( 22.62%) at least one positive specific IgE antibodies cephalosporins. , APA the CLA, CPZA cross the highest positive rate, BPO and CTO cross the lowest positive rate of 2.46% to 25.64%; CPZA-IgE antibodies detected the highest positive rate of 7.38%, CTO-IgE antibody positive rate the lowest was 2.62%. Penicillin-specific IgE antibody positive group cephalosporins specific IgE antibody positive rate was significantly higher than the penicillin-specific IgE antibody-negative group (P lt; 0.01). Major antigenic determinant of penicillin cluster IgE antibody positive group and secondary epitopes cluster IgE antibody positive group specific IgE antibodies to cephalosporins, cephalosporins major epitopes of IgE antibodies, cephalosporins secondary antigenic determinants cluster IgE antibody positive rate no significant difference (P gt; 0.05). 126 cases of patients with a history of allergy, allergic reaction symptoms were divided into three groups of anaphylactic shock (27 cases), urticaria (62 cases) and other symptoms (37 cases), the urticaria group cephalosporin class-specific IgE antibody positive rate was significantly higher than other symptomatic group (P lt; 0.01666), cephalosporins specific skin test-positive and negative groups, rapid onset allergic reaction group and delayed-type hypersensitivity group, male group and female group IgE antibody positive rate was no significant difference (P gt; 0.05). Secondary antigen decided to have the same or similar side chain structure of antibiotics correlation analysis found clusters of specific IgE antibodies, the APA-IgE AXA-IgE the APA-IgE CEXA-IgE, AXA-IgE and CEXA-IgE, BPA -IgE, CLA-IgE were positively correlated, and ampicillin, amoxicillin antibody positive group cephalexin antibody positive rate was significantly higher than the antibody-negative group (P lt; 0.05), penicillin G antibody positive and negative groups cephalosporin thiophene antibody positive rate was no significant difference (P gt; 0.05). 2.3 cephalosporin antibiotic allergy patients penicillin antibiotics and cephalosporins cephalosporins cross 34 cases of allergies allergic patients, specific IgE antibodies to detect cephalosporins, the positive rate was 35.29% (12 cases); detect of 11 cephalosporins specific IgE antibodies, the positive rate was 94.12% (32 cases). Results show that the type of antigen detection for 1-4, with the detected antigen specific IgE antibody positive rate decision cluster increasing types was significantly higher (P LT; 0.05), there was no significant difference in 5 or more kinds ( P gt; 0.05). Visible, specific IgE antibody positive rate with the type of antigen detection increased saturation. In 18 cases (52.94%) of the 34 cases of patients cephalosporins penicillins and cephalosporins cross allergic reactions, 32 cases (94.12%) were positive specific IgE antibodies to at least one of cephalosporins, 19 cases (55.88%) at least one positive penicillin specific IgE antibodies. BPO-IgE AXO-IgE antibodies, the highest positive rate was 23.53%; PVA-IgE antibody positive rate was the lowest at 0%. Except CLO-IgE and CPZO-IgE antibody, the remaining nine cephalosporins specific IgE antibody levels, patient group was significantly higher than the normal control group (P lt; 0.05). Cephalosporin antibody positive and negative groups, the skin test-positive and negative groups, speed-specific IgE antibody positive rate of hypersensitivity group and delayed-type hypersensitivity group, male group and female group penicillins and cephalosporins no statistically significant differences (P gt; 0.05). 3. Penicillin antibiotics, cephalosporins special case of the more than 646 kinds of penicillin and cephalosporin inhibitor cross allergic reaction mechanisms, the higher rate of side chain structure as well as the suppression of the structure of the nucleus. Speculated cases 646 the application of a variety of beta-lactam antibiotics, may occur a wide range of cross-allergic reactions to this have a closer relationship with the nucleus structure and side chain structure. The specialization H11 inhibitor concentration 100mmmol / L, PG (56.35%), PV (57.87%), the AP (69.54%) the CEX (57.87%), CZ (72.44%), higher inhibition rates in the CX (56.85%) and mother nucleus structure 7-ACA and the inhibition rate of the 6-APA is also high, while the low rate of several side-chain structure to suppress. Speculated that the allergic patients nucleus structure is closely related to beta-lactam antibiotics cross allergic reactions to these drugs. Special case of 1112, the CEX highest inhibition rate of 76.58%; AX followed, and the side chain structure the NPG, PHPG the inhibition rate far higher than the 6-APA ,7-ACA nucleus structure and side chain structure PHA, PHOA of inhibition rate. Speculated that the allergic patients AX and CEX cross allergic reaction occurs with the patient's body IgE antibodies specifically recognize these two drugs side chain structure related. Special case H166, CL inhibition rate highest in 100mmol / L of 77.10%, and other 10 kinds of antibiotics inhibitory rate structure and side chain structure as well as the nucleus inhibition rate was lower, suggesting that the allergic patients outside than CL other β-lactam antibiotics are not allergic reactions. Of the patient the CLO specific IgE antibody positive may be related to its specific IgE antibody in vivo identification CL drug molecules. Conclusion 1. RAST detect specific IgE antibodies cephalosporins sensitivity, specificity, and supplement the clinical diagnosis of cephalosporin antibiotics allergic reactions; 2. Cross-allergic reactions, penicillin antibiotics and cephalosporins cross allergic reaction rate of 19.82%; 3. Cephalosporins and specific IgE antibodies to the identification of the drug molecules having a higher structural specificity, and play a role in the side chain structure in the cross-allergic reaction.
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