Piperacillin-Tazobactam Hypersensitivity: A Large, Multicenter Analysis
Piperacillin-Tazobactam Hypersensitivity: A Large, Multicenter Analysis
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DOI：
10.1016/j.jaip.2020.12.051
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发表时间：
2021-05-06
影响因子：
9.4
通讯作者：
Wagner, Annette
中科院分区：
文献类型：
--
作者：
Casimir-Brown, Rosamund Sara;Kennard, Lucinda;Wagner, Annette
背景：哌拉西林/他唑巴坦是一种广谱青霉素。除了囊性纤维症患者外，过敏反应的报道比其他青霉素类药物要少。目的：详细描述一名疑似哌拉西林-他唑巴坦过敏患者的临床特征。方法：回顾分析欧洲5个过敏中心的87名患者的人口学特征、临床表现、调查和处理。患者接受了哌拉西林/他唑巴坦、主要(青霉酰聚赖氨酸)和次要决定因素(盘尼洛钠)、阿莫西林、青霉素、氟氯西林、复方阿莫西拉、克拉维酸和美罗培南的皮肤刺激性和皮内试验，并立即和适当地延迟阅读试验。皮肤试验阴性的患者接受了哌拉西林/他唑巴坦和/或其他青霉素的药物激发。结果：87例患者中，48例(55%)被诊断为对哌拉西林/他唑巴坦过敏，皮肤或药物激发试验阳性，其中10例(21%)被诊断为囊性纤维化。26例(54%)患者表现为即刻过敏，22例(45%)患者表现为非即刻超敏反应。囊性纤维化患者主要表现为非即刻超敏反应(70%)。52%的直接反应(布朗过敏反应3级)为严重反应，75%的非直接反应为中度严重(全身受累)。皮试结果为阴性的患者耐受二次注射的人数在即刻(80%)和非即刻(88%)超敏反应方面相当。三分之一的患者对其他青霉素交叉敏感。交叉致敏模式增加了3例患者发生他唑巴坦过敏的可能性。在21例对哌拉西林/他唑巴坦选择性增敏的患者中(12例是即刻的，9例是非即刻的)，药物激发试验显示对其他β-内酰胺类药物有耐受性。大多数患者对其他青霉素类药物进行了选择性增敏和耐受。有些患者可能只对β-内酰胺酶抑制剂过敏。(C)2021年美国过敏、哮喘和免疫学学会
BACKGROUND: Piperacillin/tazobactam is a broad-spectrum penicillin. Hypersensitivity reactions are less commonly reported than with other penicillins except in patients with cystic fibrosis.OBJECTIVE: Detailed clinical characterization of a patient cohort referred with suspected piperacillin-tazobactam hypersensitivity.METHODS: Retrospective analysis of the demographic characteristics, clinical presentation, investigation, and management of 87 patients presenting to 5 European allergy centers. Patients underwent skin prick and intradermal testing with piperacillin/tazobactam, major (penicilloyl-polylysine) and minor (sodium penilloate) determinants, amoxicillin, benzylpenicillin, flucloxacillin, co-amoxiclav, clavulanic acid, and meropenem with immediate and, where appropriate, delayed reading of tests. Skin test -negative patients underwent drug provocation to piperacillin/tazobactam and/or other penicillins. A multistep protocol was used, depending on risk assessment.RESULTS: Forty-eight of 87 (55%) patients were diagnosed with hypersensitivity to piperacillin/tazobactam with either positive & nbsp;skin or drug provocation test results, of whom 10 (21%) had a diagnosis of cystic fibrosis. Twenty-six (54%) patients presented with immediate and 22 (45%) with nonimmediate hypersensitivity. Patients with cystic fibrosis predominantly presented with nonimmediate hypersensitivity (70%). Reactions were severe in 52% of immediate reactors (Brown's anaphylaxis grade 3) and moderately severe (systemic involvement) in 75% of nonimmediate reactors. The number of patients with negative skin test results tolerating reintroduction was comparable in immediate (80%) and nonimmediate (88%) hypersensitivity. One-third of patients were cross-sensitized to other penicillins. The cross-sensitization pattern raised the possibility of tazobactam allergy in 3 patients. In 21 patients selectively sensitized to piperacillin/tazobactam (12 immediate, 9 nonimmediate), tolerance to other beta-lactams was demonstrated by drug provocation testing.CONCLUSIONS: Piperacillin-tazobactam caused immediate and nonimmediate hypersensitivity with similar frequency. Most patients were selectively sensitized and tolerated other penicillins. Some patients may be allergic to the beta-lactamase inhibitor only. (C) 2021 American Academy of Allergy, Asthma & Immunology