Lam Amanda, Randhawa Inderpal, Klaustermeyer William
UCLA West Los Angeles VA Medical Center 90073, USA.
Allergol Int. 2008 Sep;57(3):281-4. doi: 10.2332/allergolint.C-07-55. Epub 2008 Jul 1.
Drug hypersensitivity is classically divided into IgE mediated and non-IgE mediated disease. We report a rare case of consequent IgE mediated and non-IgE mediated reactions within the beta lactam class of antibiotics.
An 84-year-old man developed toxic epidermal necrolysis (TEN) due to ceftriaxone, a third generation cephalosporin, involving 72% of the body surface area. The patient recovered but within weeks subsequently developed an acute IgE mediated allergic reaction to piperacillin/tazobactam, an extended spectrum penicillin. Further IgE RAST revealed positive results to penicillin major determinant.
This case demonstrates the complexity of drug hypersensitivity reactions. While it is accepted that IgE mediated penicillin allergy is a predisposition to cephalosporin allergy, this case displays an unusual correlation between drug hypersensitivity and drug class. There have been few studies that evaluate the cross reactivity with penicillin or other beta-lactams in subjects with primary hypersensitivity to cephalosporins. This clinical scenario emphasizes the need of more studies on cephalosporin allergy in particular as shown by this case of sequential non-IgE mediated cephalosporin induced TEN reaction pursuant by an IgE mediated penicillin allergy.
药物超敏反应传统上分为IgE介导和非IgE介导的疾病。我们报告了一例罕见的β-内酰胺类抗生素中先后出现IgE介导和非IgE介导反应的病例。
一名84岁男性因第三代头孢菌素头孢曲松发生中毒性表皮坏死松解症（TEN），体表面积累及72%。患者康复，但数周后随后对广谱青霉素哌拉西林/他唑巴坦发生急性IgE介导的过敏反应。进一步的IgE放射变应原吸附试验显示对青霉素主要决定簇呈阳性结果。
该病例证明了药物超敏反应的复杂性。虽然公认IgE介导的青霉素过敏是头孢菌素过敏的一个易患因素，但该病例显示了药物超敏反应与药物类别之间不寻常的相关性。很少有研究评估对头孢菌素原发性超敏的受试者中与青霉素或其他β-内酰胺类药物的交叉反应性。这种临床情况强调了对头孢菌素过敏进行更多研究的必要性，特别是如该病例所示，先是非IgE介导的头孢菌素诱导的TEN反应，随后是IgE介导的青霉素过敏。
