Anaphylactic reaction to ciprofloxacin in a toddler: Successful desensitization
Anaphylactic reaction to ciprofloxacin in a toddler: Successful desensitization
复制标题
DOI：
10.1097/00006454-199906000-00022
复制
发表时间：
1999-06-01
影响因子：
3.6
通讯作者：
Assa'ad, M
中科院分区：
文献类型：
--
作者：
Erdem, G;Staat, MA;Assa'ad, M
讨论。环丙沙星和其他氟喹诺酮类药物在儿童中的使用是基于风险效益的。可能的用途包括发热性中性粒细胞减少症、尿路感染、慢性化脓性中耳炎、囊性纤维化恶化、结核分枝杆菌感染、伤寒和慢性骨髓炎（如我们的患者）。 6, 7 儿童对环丙沙星的耐受性与成人相似。 5 由于担心氟喹诺酮类药物可能引起软骨损伤，有关儿童使用环丙沙星及其不良反应的数据仍然有限。 5 我们的患者在服用环丙沙星期间出现了首剂反应，包括潮红、心动过速和迟发性皮疹。据报道，更严重的症状（如血管性水肿和低血压）以及与使用环丙沙星相关的反应（如发烧和肌痛）。 8 这些反应被标记为类过敏反应，因为其中大多数是在第一次接触药物时发生的，并且试图确定基于 IgE 的机制并未成功。 8 偶尔有成人过敏反应和脱敏的报道。 4 我们患者的反应被归类为过敏反应，因为低剂量环丙沙星皮试呈阳性，证明了 IgE 介导的致敏作用。有三例已发表的大龄儿童口服环丙沙星后出现过敏反应的病例。 5, 9 据我们所知，这是第一份关于幼儿静脉输注后过敏反应的报告，也是第一份成功静脉脱敏的报告。
Discussion. Ciprofloxacin and other fluoroquinolones are used in children on a risk-benefit basis. Possible uses have included febrile neutropenic episodes, urinary tract infections, chronic suppurative otitis media, exacerbation of cystic fibrosis, Mycobacterium tuberculosis infections, typhoid fever and chronic osteomyelitis as in our patient. 6, 7 The tolerability of ciprofloxacin in children is suggested to be similar to that in adults. 5 Because of concerns about the potential for fluoroquinolone-induced cartilage damage, data regarding ciprofloxacin use in children and its adverse effects is still limited. 5Our patient had a first-dose reaction with flushing, tachycardia and a delayed onset rash during administration of ciprofloxacin. More severe symptoms such as angioedema and hypotension and reactions such as fever and myalgias associated with ciprofloxacin usage have been reported. 8 These reactions have been labeled as anaphylactoid because the majority of them have occurred with the first exposure to the drug and attempts to identify an IgE-based mechanism have been unsuccessful. 8 There are occasional reports of anaphylaxis and desensitization in adults. 4 Our patient's reaction was classified as anaphylactic because evidence of IgE-mediated sensitization was demonstrated by a positive skin test with a low dose of ciprofloxacin. There are three published cases of anaphylaxis in older children after oral administration of ciprofloxacin. 5, 9 To our knowledge this is the first report of anaphylaxis in a young child after intravenous infusion and the first report of successful intravenous desensitization.