Department of Allergy, Southern California Permanente Medical Group, San Diego Medical Center, 7060 Clairemont Mesa Blvd., San Diego, CA, 92111, USA,
Clin Rev Allergy Immunol. 2014 Aug;47(1):46-55. doi: 10.1007/s12016-013-8369-8.
Beta-lactam intolerance, most of which is not IgE or even immunologically mediated even though it is commonly called an "allergy," can be safely managed using the following seven steps: 1. Avoid testing, re-challenging, or desensitizing individuals with histories of beta-lactam associated toxic epidermal necrolysis, Stevens-Johnson syndrome, drug reaction with eosinophilia and systemic symptoms syndrome, severe hepatitis, interstitial nephritis, or hemolytic anemia. 2. Avoid unnecessary antibiotic use, especially in the setting of viral infections. 3. Expect new intolerances to be reported after 0.5 to 4% of all antibiotic utilizations, dependent on gender and the specific antibiotic used. 4. Expect a higher incidence of new intolerances in individuals with three or more medication intolerances already noted in their medical records. 5. For individuals with an appropriate penicillin class antibiotic intolerance based on a history of anaphylaxis, urticaria, macular papular rashes, unknown symptoms, or symptoms not excluded in step one, proceed with penicillin skin testing. Skin test with penicilloyl-poly-lysine and native penicillin. If skin test is negative, proceed with an oral amoxicillin challenge. If skin test and oral challenge are negative, penicillin class antibiotics may be used. If skin test or oral challenge is positive, avoid penicillin class antibiotics. If skin test or oral challenge is positive, non-penicillin-beta-lactams may be used, unless there is a history of intolerance to a specific non-penicillin-beta-lactam, then avoid that specific non-penicillin-beta-lactam. If there is life-threatening infection that can only be treated with a penicillin class antibiotic, proceed with oral penicillin desensitization prior to any oral or parenteral penicillin use. 6. For individuals with an appropriate non-penicillin-beta-lactam intolerance, avoid re-exposure to the beta-lactam implicated. An alternative beta-lactam may be used, ideally with different side chains. Penicillin allergy testing is not useful in the management of non-penicillin-beta-lactam intolerance. Non-penicillin-beta-lactam skin testing is not clinically useful and should not be done outside of a research setting. If the non-penicillin-beta-lactam implicated is needed to treat a life-threatening infection, proceed with desensitization. 7. Be ready to treat anaphylaxis with all parenteral beta-lactam use.
β-内酰胺不耐受，其中大多数并非 IgE 介导，甚至不是免疫介导的，尽管通常被称为“过敏”，但可以通过以下七个步骤安全管理：
避免对有β-内酰胺相关中毒性表皮坏死松解症、史蒂文斯-约翰逊综合征、药物反应伴嗜酸性粒细胞增多和全身症状综合征、严重肝炎、间质性肾炎或溶血性贫血病史的个体进行测试、重新挑战或脱敏。
避免不必要的抗生素使用，特别是在病毒感染的情况下。
预计在所有抗生素使用的 0.5%至 4%的情况下，会报告新的不耐受，具体取决于性别和使用的特定抗生素。
在已经记录了三种或更多种药物不耐受的个体中，预计新的不耐受发生率更高。
对于有青霉素类抗生素过敏史的个体，如果根据过敏反应、荨麻疹、斑丘疹、未知症状或步骤 1 中排除的症状，基于病史进行青霉素皮试。皮试使用青霉素酰基-聚赖氨酸和天然青霉素。如果皮试阴性，则进行口服阿莫西林挑战。如果皮试和口服挑战均为阴性，则可使用青霉素类抗生素。如果皮试或口服挑战阳性，则避免使用青霉素类抗生素。如果皮试或口服挑战阳性，则可使用非青霉素类β-内酰胺类药物，但前提是对特定非青霉素类β-内酰胺类药物不耐受，然后避免使用该特定非青霉素类β-内酰胺类药物。如果有危及生命的感染，只能使用青霉素类抗生素治疗，则在使用任何口服或静脉内青霉素之前，先进行口服青霉素脱敏。
对于有适当非青霉素类β-内酰胺不耐受的个体，避免再次接触涉及的β-内酰胺。可以使用另一种β-内酰胺类药物，理想情况下具有不同的侧链。在管理非青霉素类β-内酰胺不耐受时，青霉素过敏测试没有用处。非青霉素类β-内酰胺类皮肤测试在临床实践中没有用处，不应在研究环境之外进行。如果需要使用非青霉素类β-内酰胺类药物来治疗危及生命的感染，则进行脱敏。
准备好在使用所有静脉内β-内酰胺类药物时治疗过敏反应。
