Tolerability of Aztreonam in Patients with Cell-Mediated Allergy to β-Lactams
Tolerability of Aztreonam in Patients with Cell-Mediated Allergy to β-Lactams
复制标题
DOI：
10.1159/000318844
复制
发表时间：
2011-01-01
影响因子：
2.8
通讯作者：
Schiavino, D.
中科院分区：
文献类型：
--
作者：
Buonomo, A.;Nucera, E.;Schiavino, D.
背景资料：氨曲南和β-内酰胺类药物之间的交叉反应性较差，但在少数IgE介导的β-内酰胺类药物过敏患者中评估了氨曲南的耐受性。本研究的目的是评估氨曲南与其他β-内酰胺类药物的交叉反应性及其在细胞介导的对这些药物过敏的患者中的耐受性。研究方法：我们研究了78例细胞介导的β-内酰胺类药物过敏的患者，这些患者接受了皮肤点刺、立即和延迟读取皮内试验以及青霉素-多聚赖氨酸、次要决定簇混合物、半合成青霉素、头孢菌素、氨曲南和亚胺培南的斑贴试验。氨曲南过敏试验阴性的患者接受肌内试验给药，并观察3小时。结果如下：我们的患者发生了94例非即刻反应;迟发型荨麻疹（34例）、斑丘疹性皮疹（13例）、荨麻疹/血管性水肿（15例）和瘙痒性红斑（13例）是报告最多的症状。阿莫西林（35例）、氨苄西林（28例）和巴氨西林（18例）是最常见的药物。所有患者对至少1种β-内酰胺类抗生素的斑贴试验和/或延迟读数皮内试验均呈阳性，无患者对氨曲南的斑贴试验或延迟读数皮内试验呈阳性。然后，65名患者接受了肌内注射aztroenam的试验剂量，没有一人出现临床反应。结论：我们的数据证实了β-内酰胺类药物和氨曲南在细胞介导的对这些药物过敏的患者中缺乏交叉反应性。延迟读数皮内试验和氨曲南斑贴试验是一种简单快速的诊断工具，可用于确定β-内酰胺过敏患者的耐受性。版权所有（c）2010 S. Karger AG，巴塞尔
Background: Cross-reactivity between aztreonam and beta-lactams is poor, but tolerability of aztreonam has been assessed in a few groups of patients suffering from IgE-mediated allergy to beta-lactams. The aim of this study was to assess the cross-reactivity of aztreonam with other beta-lactams and its tolerability in patients with cell-mediated allergy to these drugs. Methods: We studied 78 patients with cell-mediated allergy to beta-lactams who underwent skin prick, immediate and delayed-reading intradermal tests as well as patch tests with penicilloyl-polylysine, minor determinant mixture, semi-synthetic penicillins, cephalosporins, aztreonam and imipenem. Patients with negative allergy testing with aztreonam underwent an intramuscular test dosing and were observed for 3 h. Results: Our patients experienced 94 non-immediate reactions; delayed-onset urticaria (34 cases), maculopapular exanthema (13 cases), urticaria/angioedema (15 cases) and itching erythema (13 cases) were the most reported symptoms. Amoxicillin (35 cases), ampicillin (28 cases) and bacampicillin (18 cases) were the most involved drugs. All patients had a positive patch test and/or a positive delayed-reading intradermal test to at least 1 beta-lactam antibiotic and none had a positive patch or delayed-reading intradermal test to aztreonam. Then, 65 patients underwent intramuscular test dosing with aztroenam, and none of them had a clinical reaction. Conclusions: Our data confirm the lack of cross-reactivity between beta-lactams and aztreonam in patients with cell-mediated allergy to these drugs. Delayed-reading intradermal tests and patch tests with aztreonam represent a simple and rapid diagnostic tool to establish tolerability in beta-lactam-allergic patients. Copyright (c) 2010 S. Karger AG, Basel