Allergy Service, Plaza del Hospital Civil, Pabellón 5 Sótano, Carlos Haya Hospital, Pabellon C, Málaga 29009, Spain.
Med Clin North Am. 2010 Jul;94(4):805-20, xii. doi: 10.1016/j.mcna.2010.04.006.
Beta-lactam antibiotics are the drugs most frequently involved in drug hypersensitivity reactions that are mediated by specific immunologic mechanisms. In addition to benzylpenicillin, several chemical structures belonging to 5 major subgroups can induce reactions. The most relevant structure is that of the amoxicillin molecule. Reactions belong to the 4 major mechanisms described by Coombs and Gell, whereby type IV reactions have recently been further subclassified. The most frequent reactions are type I, which are IgE mediated, and type IV, which are nonimmediate and T-cell dependent. IgE-specific antibodies may recognize the benzylpenicilloyl structure or another part of the molecule, such as the side chain, as antigenic determinants. Depending on specific recognition, subjects can be either cross-reactors or selective responders. A variety of entities exist in T-cell reactions, ranging from mild exanthema to life-threatening, severe reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis. Diagnostic tests for IgE-mediated reactions can be done in vivo by testing skin with different penicillin determinants or in vitro by quantitating specific IgE antibodies. For nonimmediate reactions, there are also in vitro and in vivo tests, with variable degrees of sensitivity and specificity. The natural history of IgE-mediated reactions indicates that the count of specific IgE antibodies decreases over time and that results of diagnostic tests can become negative.
β-内酰胺类抗生素是最常涉及药物超敏反应的药物，这些反应是由特定的免疫机制介导的。除了苄青霉素外，还有几种化学结构属于 5 个主要亚群，可以引起反应。最相关的结构是阿莫西林分子。反应属于 Coombs 和 Gell 描述的 4 种主要机制，其中最近又对 IV 型反应进行了进一步分类。最常见的反应是 I 型，即 IgE 介导的反应，和 IV 型，即非即刻和 T 细胞依赖性反应。IgE 特异性抗体可能识别苄青霉素酰基结构或分子的其他部分，如侧链，作为抗原决定簇。根据特定的识别，患者可以是交叉反应者或选择性反应者。T 细胞反应存在多种实体，从轻度皮疹到危及生命的严重反应，如史蒂文斯-约翰逊综合征或中毒性表皮坏死松解症。针对 IgE 介导的反应的诊断测试可以通过用不同的青霉素决定簇测试皮肤来进行体内测试，或者通过定量特定的 IgE 抗体来进行体外测试。对于非即刻反应，也有体外和体内测试，具有不同的敏感性和特异性。IgE 介导的反应的自然史表明，特异性 IgE 抗体的数量随时间减少，并且诊断测试的结果可能变为阴性。
