Update on the management of antibiotic allergy.
Update on the management of antibiotic allergy.
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DOI：
10.4168/aair.2010.2.2.77
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发表时间：
2010-04
期刊：
影响因子：
--
通讯作者：
Thong BY
中科院分区：
文献类型：
--
作者：
Thong BY
对抗生素的药物过敏可能以速发型或非速发型（迟发型）超敏反应的形式发生。速发型反应通常是IgE介导的，而非速发型超敏反应通常是非IgE或T细胞介导的。抗生素过敏的临床表现可以是皮肤的、器官特异性的（例如，血液功能障碍，肝炎，间质性肾炎），全身性（例如，过敏反应、药物诱导的超敏反应综合征）或这些的各种组合。表现为史蒂文斯约翰逊综合征或中毒性表皮坏死松解症（TEN）的重度皮肤不良反应可能危及生命。抗生素过敏的管理始于从详细和准确的药物历史中识别推定的抗生素，并辅以经验证的体内和体外过敏试验。这将有助于通过患者教育、使用药物警示卡以及内置药物过敏/药物不良反应处方和配药检查的电子病历来避免使用推定的抗生素。了解特定抗生素交叉反应的证据在患者教育中也很重要。除了停用假定的抗生素外，免疫调节剂如大剂量静脉注射免疫球蛋白可能在TEN中起作用。在某些情况下，如果利益大于风险，并且由于各种原因无法使用替代抗生素，则可以考虑药物脱敏。与电子药物过敏警报，计算机化的医生处方和决策支持系统，抗生素降级抗菌药物管理计划有关的过敏问题也进行了讨论。
Drug allergy to antibiotics may occur in the form of immediate or non-immediate (delayed) hypersensitivity reactions. Immediate reactions are usually IgE-mediated whereas non-immediate hypersensitivity reactions are usually non-IgE or T-cell mediated. The clinical manifestations of antibiotic allergy may be cutaneous, organ-specific (e.g., blood dyscracias, hepatitis, interstitial nephritis), systemic (e.g., anaphylaxis, drug induced hypersensitivity syndrome) or various combinations of these. Severe cutaneous adverse reactions manifesting as Stevens Johnson syndrome or toxic epidermal necrolysis (TEN) may be potentially life-threatening. The management of antibiotic allergy begins with the identification of the putative antibiotic from a detailed and accurate drug history, complemented by validated in-vivo and in-vitro allergological tests. This will facilitate avoidance of the putative antibiotic through patient education, use of drug alert cards, and electronic medical records with in-built drug allergy/adverse drug reaction prescription and dispensing checks. Knowledge of the evidence for specific antibiotic cross-reactivities is also important in patient education. Apart from withdrawal of the putative antibiotic, immunomodulatory agents like high-dose intravenous immunoglobulins may have a role in TEN. Drug desensitization where the benefits outweigh the risks, and where no alternative antibiotics can be used for various reasons, may be considered in certain situations. Allergological issues pertaining to electronic drug allergy alerts, computerized physician prescriptions and decision support systems, and antibiotic de-escalation in antimicrobial stewardship programmes are also discussed.
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