IgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of alternative cephalosporins
IgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of alternative cephalosporins
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DOI：
10.1016/j.jaci.2015.03.012
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发表时间：
2015-09-01
影响因子：
14.2
通讯作者：
Quaratino, Donato
中科院分区：
文献类型：
--
作者：
Romano, Antonino;Gaeta, Francesco;Quaratino, Donato
背景资料：关于替代头孢菌素在IgE介导的头孢菌素超敏反应的大样本受试者中的交叉反应性和耐受性的研究缺乏目的：我们试图评估在特别需要头孢菌素过敏的受试者中使用替代头孢菌素的可能性。102例对头孢菌素类药物有即时反应且皮肤试验结果阳性的受试者接受了血清特异性IgE测定，头孢克洛和不同头孢菌素的皮肤试验。受试者分为4组：A组，对头孢曲松、头孢呋辛、头孢噻肟、头孢吡肟、头孢地嗪和头孢他啶中的一种或多种的阳性反应; B组，对氨基头孢菌素类的阳性反应; C组，对上述组以外的头孢菌素类的阳性反应; D组，对属于2个不同组的头孢菌素类的阳性反应。A组受试者接受了头孢克洛、头孢唑林和头孢布烯的挑战; B组受试者接受了头孢呋辛酯、头孢曲松、头孢唑林和头孢布烯的挑战; C组和D组受试者接受了根据其阳性模式选择的上述头孢菌素的挑战。A组有73例受试者，B组有13例，C组有7例，D组有9例。挑战与替代头孢菌素（头孢布烯在101，头孢唑林在96，头孢克洛在82，头孢呋辛酯和头孢曲松在22个subjects.Conclusions）是良好的耐受性：头孢菌素过敏似乎不是一类过敏。特别需要替代头孢菌素的头孢菌素过敏受试者，可使用具有与相应头孢菌素不同的侧链决定簇且治疗前皮试反应阴性的化合物进行治疗。
Background: Studies regarding the cross-reactivity and tolerability of alternative cephalosporins in large samples of subjects with an IgE-mediated hypersensitivity to cephalosporins are lacking.Objective: We sought to evaluate the possibility of using alternative cephalosporins in subjects with cephalosporin allergy who especially require them.Methods: One hundred two subjects with immediate reactions to cephalosporins and positive skin test results to the responsible drugs underwent serum specific IgE assays with cefaclor and skin tests with different cephalosporins. Subjects were classified in 4 groups: group A, positive responses to 1 or more of ceftriaxone, cefuroxime, cefotaxime, cefepime, cefodizime, and ceftazidime; group B, positive responses to aminocephalosporins; group C, positive responses to cephalosporins other than those belonging to the aforementioned groups; and group D, positive responses to cephalosporins belonging to 2 different groups. Group A subjects underwent challenges with cefaclor, cefazolin, and ceftibuten; group B participants underwent challenges with cefuroxime axetil, ceftriaxone, cefazolin, and ceftibuten; and group C and D subjects underwent challenges with some of the aforementioned cephalosporins selected on the basis of their patterns of positivity.Results: There were 73 subjects in group A, 13 in group B, 7 in group C, and 9 in group D. Challenges with alternative cephalosporins (ceftibuten in 101, cefazolin in 96, cefaclor in 82, and cefuroxime axetil and ceftriaxone in 22 subjects) were well tolerated.Conclusions: Cephalosporin hypersensitivity does not seem to be a class hypersensitivity. Subjects with cephalosporin allergy who especially require alternative cephalosporins might be treated with compounds that have side-chain determinants different from those of the responsible cephalosporins and have negative pretreatment skin test responses.