Guéant Jean-Louis, Guéant-Rodriguez Rosa-Maria, Viola Marinella, Valluzzi Rocco Luigi, Romano Antonino
Inserm U-724, Laboratoire de Pathologie Cellulaire et Moléculaire en Nutrition and Department of Clinical Biochemistry, University Hospital Center of Nancy and Medical Faculty, University Henry Poincaré, 54500, Nancy, France.
Curr Pharm Des. 2006;12(26):3335-45. doi: 10.2174/138161206778194060.
Like penicillins, cephalosporins may cause IgE-mediated reactions such as urticaria, angioedema, and anaphylactic shock, which occur because of sensitization to determinants shared with penicillins or to unique cephalosporin haptens. In particular, side-chain structures may be responsible for selective sensitization or cross-reactivity. For this reason, individual free cephalosporins are usually employed in skin testing, in addition to the classic penicillin reagents. Cephalosporin skin tests are sensitive in diagnosing immediate hypersensitivity to these betalactams. As far as in vitro tests are concerned, IgE assays for cephalosporins, specifically sepharose-radioimmunoassays, are a potentially useful tool in evaluating immediate reactions and could be used as complementary tests. In selected cases displaying negative results in both skin tests and IgE assays, a graded challenge with the implicated cephalosporin can be performed. Cephalosporin IgE-mediated hypersensitivity may be a transient condition; therefore, allergologic exams should be repeated in patients with negative initial allergologic work-ups, including challenges. Performing allergologic tests with cephalosporins other than the culprit, as well as with penicillin reagents, allows the identification of cross-reactivity with penicillins, selective responses, or cross-reactivity among cephalosporins. In the latter group, cross-reactivity is more frequently related to R1 than to R2 side-chain recognition. In assessing the selectivity of the response, negative results in skin testing with cephalosporins other than the responsible one appear to be a reliable indicator of tolerability.
与青霉素一样，头孢菌素可能引起IgE介导的反应，如荨麻疹、血管性水肿和过敏性休克，这些反应是由于对与青霉素共有的决定簇或独特的头孢菌素半抗原致敏所致。特别是，侧链结构可能是选择性致敏或交叉反应的原因。因此，除了经典的青霉素试剂外，通常还使用单独的游离头孢菌素进行皮肤试验。头孢菌素皮肤试验在诊断对这些β-内酰胺类药物的速发型超敏反应方面很敏感。就体外试验而言，头孢菌素的IgE检测，特别是琼脂糖放射免疫测定，是评估速发型反应的潜在有用工具，可作为补充试验。在皮肤试验和IgE检测均显示阴性结果的特定病例中，可以对相关头孢菌素进行分级激发试验。头孢菌素IgE介导的超敏反应可能是一种短暂的情况；因此，对于初始过敏检查（包括激发试验）结果为阴性的患者，应重复进行过敏检查。使用除致病药物外的其他头孢菌素以及青霉素试剂进行过敏试验，可以确定与青霉素的交叉反应、选择性反应或头孢菌素之间的交叉反应。在后一组中，交叉反应与R1侧链识别的相关性比与R2侧链识别的相关性更高。在评估反应的选择性时，用除致病药物外的其他头孢菌素进行皮肤试验的阴性结果似乎是耐受性的可靠指标。
