Misirlioglu Emine Dibek, Guvenir Hakan, Toyran Muge, Vezir Emine, Capanoglu Murat, Civelek Ersoy, Buyuktiryaki Betul, Ginis Tayfur, Kocabas Can Naci
Allergy Asthma Proc. 2017 Sep 1;38(5):376-382. doi: 10.2500/aap.2017.38.4065.
Beta-lactam antibiotics (BLA) are the most commonly prescribed antibiotics and are responsible for the majority of immediate hypersensitivity reactions to drugs in children. Cross-reactivity is important in hypersensitivity to BLAs because these drugs all share a common beta-lactam structure and some share similar side chains.
The aim of this study was to evaluate the clinical characteristics of patients who are diagnosed with immediate-type BLA hypersensitivity and frequency of patients with side chain hypersensitivity, "selective responders."
The study included patients who were diagnosed with immediate-type BLA hypersensitivity between January 2011 and May 2016 in a pediatric allergy outpatient clinic. The patients who had negative penicillin test (minor determinant mixture, benzylpenicilloylpoly-L-lysine, penicillin G) results and could tolerate penicillin V and/or BLAs with dissimilar side chains but had positive skin and/or provocation test results with the suspected drug were diagnosed as selective responders.
During the study period, 357 patients (55.2% girls) were admitted to our clinic with suspected immediate-type BLA hypersensitivity. Parents of 11 patients did not give consent for an allergy workup with the suspected drug. Forty-five of the patients were diagnosed (45/346 [13%]) based on skin test or drug provocation test results. The most common susceptible agent was amoxicillin-clavulanate. Of the patients, 71.4% with a reaction to sulbactam-ampicillin /or amoxicillin-clavulanate and 93.7% with a reaction to cephalosporin were classified as selective responders.
Among children with immediate BLA hypersensitivity, selective responders constituted an important group. Most of the patients with reactions to aminopenicillin and cephalosporins safely tolerated penicillin V and BLAs with dissimilar side chains after negative allergy workup results.
β-内酰胺类抗生素（BLA）是最常用的抗生素，也是儿童药物速发型超敏反应的主要原因。交叉反应在BLA超敏反应中很重要，因为这些药物都具有共同的β-内酰胺结构，并且一些药物具有相似的侧链。
本研究的目的是评估被诊断为速发型BLA超敏反应患者的临床特征以及侧链超敏反应患者（“选择性反应者”）的频率。
该研究纳入了2011年1月至2016年5月在儿科过敏门诊被诊断为速发型BLA超敏反应的患者。青霉素试验（次要决定簇混合物、苄青霉素酰聚-L-赖氨酸、青霉素G）结果为阴性且能耐受青霉素V和/或具有不同侧链的BLA，但对疑似药物的皮肤和/或激发试验结果为阳性的患者被诊断为选择性反应者。
在研究期间，357例患者（55.2%为女孩）因疑似速发型BLA超敏反应入住我们的诊所。11例患者的父母不同意对疑似药物进行过敏检查。45例患者根据皮肤试验或药物激发试验结果被诊断（45/346[13%]）。最常见的易感药物是阿莫西林-克拉维酸。在对舒巴坦-氨苄西林/或阿莫西林-克拉维酸有反应的患者中，71.4%以及对头孢菌素类有反应的患者中，93.7%被归类为选择性反应者。
在速发型BLA超敏反应的儿童中，选择性反应者构成了一个重要群体。大多数对氨基青霉素和头孢菌素类有反应的患者在过敏检查结果为阴性后能够安全地耐受青霉素V和具有不同侧链的BLA。
