Patriarca G, Schiavino D, Lombardo C, Altomonte G, De Cinti M, Buonomo A, Nucera E
Allergy Unit, Policlinico Gemelli, Catholic University of the Sacred Heart, Largo Gemelli 8, Rome, Italy.
Int J Immunopathol Pharmacol. 2008 Apr-Jun;21(2):375-9. doi: 10.1177/039463200802100215.
Cross-reactivity between aztreonam and penicillins is poor, but clinical tolerance of aztreonam has been assessed, by means of tolerance challenge tests, only in a few groups of penicillin-allergic patients. The aim of this study is to evaluate the tolerability of aztreonam in a large group of beta-lactam-allergic patients. We studied all patients (greater than 14 years of age), with a clinical history of immediate reactions to any beta-lactam and with positive immediate-type skin tests and/or positive specific IgE to any of the studied beta-lactam; they were studied by means of: skin prick and intradermal tests with penicilloyl polylysine, minor determinant mixture, semisynthetic penicillins, cephalosporins, aztreonam and imipenem; detection of specific IgE to penicillin G, penicillin V, ampicillin, amoxicillin, cefaclor and ceftriaxone. Patients with negative immediate-type skin tests with aztreonam then underwent a graded intramuscular challenge. Forty-five patients (mean age 46.1 +/- 15.2 years), 27 females and 18 males, had positive skin tests and/or specific IgE to at least one of the studied beta-lactams. The most involved drugs were amoxicillin (23 cases), ampicillin (9 cases), penicillin G (8 cases) and other beta-lactams in the remaining cases. The most frequent reactions were anaphylaxis (27 cases) and urticaria (15 cases). All patients had negative intradermal tests with aztreonam and all patients tolerated the intramuscular graded challenge. Our data confirm the lack of cross-reactivity between beta-lactams and aztreonam. Immediate-type skin tests with aztreonam represent a simple and rapid diagnostic tool to establish tolerability in beta-lactam-allergic patients who urgently need this drug.
氨曲南与青霉素之间的交叉反应性较差，但仅在少数几组青霉素过敏患者中通过耐受性激发试验评估了氨曲南的临床耐受性。本研究的目的是评估氨曲南在一大组β-内酰胺类过敏患者中的耐受性。我们研究了所有年龄大于14岁、有对任何β-内酰胺类药物速发型反应的临床病史且对任何研究的β-内酰胺类药物速发型皮肤试验阳性和/或特异性IgE阳性的患者；通过以下方式对他们进行研究：用青霉噻唑聚赖氨酸、次要决定簇混合物、半合成青霉素、头孢菌素、氨曲南和亚胺培南进行皮肤点刺和皮内试验；检测对青霉素G、青霉素V、氨苄西林、阿莫西林、头孢克洛和头孢曲松的特异性IgE。对氨曲南速发型皮肤试验阴性的患者随后进行了分级肌内激发试验。45例患者（平均年龄46.1±15.2岁），27例女性和18例男性，对至少一种研究的β-内酰胺类药物皮肤试验阳性和/或特异性IgE阳性。涉及最多的药物是阿莫西林（23例）、氨苄西林（9例）、青霉素G（8例），其余病例为其他β-内酰胺类药物。最常见的反应是过敏反应（27例）和荨麻疹（15例）。所有患者氨曲南皮内试验均为阴性，所有患者均耐受肌内分级激发试验。我们的数据证实了β-内酰胺类药物与氨曲南之间缺乏交叉反应性。对氨曲南进行速发型皮肤试验是一种简单快速的诊断工具，可用于确定急需该药物的β-内酰胺类过敏患者的耐受性。
