Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.
Reference Center for Toxic Bullous Diseases and Severe Cutaneous Adverse Reactions, Créteil, France.
J Eur Acad Dermatol Venereol. 2020 Apr;34(4):787-794. doi: 10.1111/jdv.15986. Epub 2019 Oct 28.
Cross-reactivity among beta-lactam antibiotics (BL) is essentially reported in immediate hypersensitivity.
To evaluate cross-reactivity beyond BLs in patients with non-immediate cutaneous adverse drug reaction (non-immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs.
PATIENTS/MATERIALS/METHODS: We conducted a retrospective single-centre study in consecutive patients consulting between 2010 and 2018 with an active BL-suspected non-immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P-IDR)] for at least three penicillin's subclasses and amino- and non-amino-cephalosporins (at least one aminocephalosporin). Cross-reactivity among subclasses was investigated for patients with positive tests.
We included 56 patients, among whom 46 amoxicillin-suspected were and seven cephalosporin-suspected. Twenty-nine had severe CADR, and 27 had non-immediate maculopapular exanthema (MPE). Twenty-two had positive tests (18 for AS and four for CS). Among the 18 positive amoxicillin-suspected, 10 (55.6%) showed cross-reactivity with one or more other BL: 9 (50%) with another penicillin and 3 (16.5%) with a non-aminocephalosporin. No amoxicillin- or cephalosporin-suspected patient showed cross-reactivity with aztreonam or carbapenems. P-IDR showed cross-reactivity only once.
After a suspected BL-induced non-immediate CADR, a large allergologic exploration is needed to confirm the diagnosis and evaluate cross-reactivity. In our population including cases of severe CADRs and MPE with late delay of onset, cross-reactivity was frequent and PT was sufficient to this purpose. The frequent cross-reactivity among penicillins encourages stopping this whole family and to test cephalosporins, aztreonam and carbapenems for which cross-allergies are rarer.
β-内酰胺类抗生素（BL）之间的交叉反应主要见于速发型过敏反应。
评估皮肤科中毒性大疱和严重药物不良反应（CADR）参考中心管理的非即刻性皮肤不良反应（非即刻 CADR）患者对 BL 以外药物的交叉反应。
患者/材料/方法：我们对 2010 年至 2018 年间因疑似 BL 引起的非即刻 CADR 就诊且接受皮肤试验（斑贴试验[PT]和皮内试验[P-IDR]）的连续患者进行了回顾性单中心研究，至少对三种青霉素亚类和氨基及非氨基头孢菌素（至少一种氨基头孢菌素）进行了探索。对阳性试验患者进行亚类间交叉反应的研究。
我们共纳入 56 例患者，其中 46 例疑为阿莫西林，7 例疑为头孢菌素。29 例为严重 CADR，27 例为非即刻斑丘疹性发疹（MPE）。22 例试验阳性（18 例 AS，4 例 CS）。在 18 例疑似阿莫西林阳性患者中，10 例（55.6%）与一种或多种其他 BL 发生交叉反应：9 例（50%）与另一种青霉素，3 例（16.5%）与非氨基头孢菌素。无阿莫西林或头孢菌素疑似患者与氨曲南或碳青霉烯类药物发生交叉反应。皮内试验仅显示一次交叉反应。
在疑似 BL 引起的非即刻 CADR 后，需要进行广泛的过敏反应检测以确认诊断并评估交叉反应。在包括严重 CADR 和迟发性 MPE 病例的人群中，交叉反应频繁，PT 可满足此目的。青霉素之间频繁的交叉反应促使停止使用整个家族，并对头孢菌素、氨曲南和碳青霉烯类药物进行测试，因为这些药物的交叉过敏反应较少。
