IMMEDIATE ALLERGIC REACTIONS TO AMOXICILLIN

被引:66
作者
VEGA, JM
BLANCA, M
GARCIA, JJ
CARMONA, MJ
MIRANDA, A
PEREZESTRADA, M
FERNANDEZ, S
ACEBES, JM
TERRADOS, S
机构
[1] CARLOS HAYA REG HOSP,ALLERGY SECT,PABELLON C HOSP SAN JUAN DE DIOS,PLAZA HOSP CIVIL S-N,E-29009 MALAGA,SPAIN
[2] TORRECARDENAS HOSP,ALMERIA,SPAIN
关键词
AMOXICILLIN; ANAPHYLAXIS; PENICILLIN; RAST; SKIN TESTS;
D O I
10.1111/j.1398-9995.1994.tb02275.x
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
A large group of patients with suspected allergic reactions to beta-lactam antibiotics was evaluated. A detailed clinical history, together with skin tests, RAST (radioallergosorbent test), and controlled challenge tests, was used to establish whether patients allergic to beta-lactam antibiotics had selective immediate allergic responses to amoxicillin (AX) or were cross-reacting with other penicillin derivatives. Skin tests were performed with benzylpenicilloyl-poly-L-lysine (BPO-PLL), benzylpenicilloate, benzylpenicillin (PG), ampicillin (AMP), and AX. RAST for BPO-PLL and AX-PLL was done. When both skin test and RAST for BPO were negative, single-blind, placebo-controlled challenge tests were done to ensure tolerance of PG or sensitivity to AX. A total of 177 patients were diagnosed as allergic to beta-lactam antibiotics. We selected the 54 (30.5%) cases of immediate AX allergy with good tolerance of PG. Anaphylaxis was seen in 37 patients (69%), the other 17 (31%) having urticaria and/or angioedema. All the patients were skin test negative to BPO; 49 of 51 (96%) were also negative to MDM, and 44 of 46 (96%) to PG. Skin tests with AX were positive in 34 (63%) patients. RAST was positive for AX in 22 patients (41%) and to BPO in just 5 (90%). None of the sera with negative RAST for AX were positive to BPO. Challenge tests with AX were performed in 23 subjects (43%) to establish the diagnosis of immediate allergic reaction to AX, and in 15 cases (28%) both skin test and RAST for AX were negative. PG was well tolerated by all 54 patients. We describe the largest group of AX-allergic patients who have tolerated PG reported so far. Diagnosis of these patients can be achieved only if specific AX-related reagents are employed. Further studies are necessary to determine the exact extent of this problem and to improve the efficacy of diagnostic methods.
引用
收藏
页码:317 / 322
页数:6
相关论文
共 32 条
[1]   IMMUNOLOGY OF THE MONOBACTAM AZTREONAM [J].
ADKINSON, NF ;
SWABB, EA ;
SUGERMAN, AA .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 1984, 25 (01) :93-97
[2]   PENICILLIN ALLERGY - CAN THE INCIDENCE BE REDUCED [J].
AHLSTEDT, S .
ALLERGY, 1984, 39 (03) :151-164
[3]   ALLERGIC REACTIONS TO DRUGS AND BIOLOGIC AGENTS [J].
ANDERSON, JA ;
ADKINSON, NF .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1987, 258 (20) :2891-2899
[4]  
BATCHELOR FR, 1966, IMMUNOLOGY, V10, P21
[5]   CROSS-REACTIVITY BETWEEN PENICILLINS AND CEPHALOSPORINS - CLINICAL AND IMMUNOLOGICAL STUDIES [J].
BLANCA, M ;
FERNANDEZ, J ;
MIRANDA, A ;
TERRADOS, S ;
TORRES, MJ ;
VEGA, JM ;
AVILA, MJ ;
PEREZ, E ;
GARCIA, JJ ;
SUAU, R .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 1989, 83 (02) :381-385
[6]   ALLERGY TO PENICILLIN WITH GOOD TOLERANCE TO OTHER PENICILLINS - STUDY OF THE INCIDENCE IN SUBJECTS ALLERGIC TO BETA-LACTAMS [J].
BLANCA, M ;
VEGA, JM ;
GARCIA, J ;
CARMONA, MJ ;
TERADOS, S ;
AVILA, MJ ;
MIRANDA, A ;
JUAREZ, C .
CLINICAL AND EXPERIMENTAL ALLERGY, 1990, 20 (05) :475-481
[7]   IMMEDIATE HYPERSENSITIVITY REACTIONS TO PENICILLIN AND RELATED ANTIBIOTICS [J].
BLANCA, M ;
VEGA, JM ;
GARCIA, JJ ;
CARMONA, MJ ;
MIRANDA, A .
CLINICAL AND EXPERIMENTAL ALLERGY, 1989, 19 (05) :556-557
[8]   ANAPHYLAXIS TO AMOXYCILLIN BUT GOOD TOLERANCE FOR BENZYL PENICILLIN - INVIVO AND INVITRO STUDIES OF SPECIFIC IGE ANTIBODIES [J].
BLANCA, M ;
PEREZ, E ;
GARCIA, J ;
MIRANDA, A ;
FERNANDEZ, J ;
VEGA, JM ;
TERRADOS, S ;
AVILA, M ;
MARTIN, A ;
SUAU, R .
ALLERGY, 1988, 43 (07) :508-510
[9]   3 EPITOPE-SPECIFIC MONOCLONAL-ANTIBODIES AGAINST THE HAPTEN PENICILLIN [J].
DEHAAN, P ;
DEJONGE, AJR ;
VERBRUGGE, T ;
BOORSMA, DM .
INTERNATIONAL ARCHIVES OF ALLERGY AND APPLIED IMMUNOLOGY, 1985, 76 (01) :42-46
[10]  
DONOWITZ GR, 1988, NEW ENGL J MED, V318, P419