Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal.
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Contact Dermatitis. 2020 May;82(5):290-296. doi: 10.1111/cod.13462. Epub 2020 Feb 3.
Antibiotics have been implicated in the reactivation of exanthema and systemic involvement in drug reaction with eosinophilia and systemic symptoms (DRESS); however, it is not clear whether these patients become sensitized to the antibiotic.
To evaluate if, after DRESS, patients become sensitized to antibiotics.
We retrospectively reviewed the patch test (PT) data and clinical files of DRESS patients who were administered antibiotics during DRESS from other culprits.
Nine patients out of 17 (53%) were positive to antibiotics in PT: six to the penicillin group and three to cephalosporins (including one patient with additional positivity to vancomycin). Considering the eight patients who were negative to antibiotics in PT, seven were exposed to a fluoroquinolone. Four cases were patch tested again and three remained positive to antibiotics 2 to 5 years thereafter. Two patients with positive PT results had an accidental re-exposure to antibiotics and developed a maculopapular exanthema without systemic symptoms.
Exposure to antibiotics during DRESS or its prodromal phase could enhance sensitization to antibiotics, as confirmed by a positive PT. Reproducibility of positive PTs to antibiotics after several years and reactivation after re-exposure support that T-cell-mediated hypersensitivity to antibiotics in the setting of DRESS is a specific reaction.
抗生素与出疹和药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）的全身受累的再激活有关；然而，目前尚不清楚这些患者是否对抗生素产生了致敏。
评估 DRESS 后患者是否对抗生素产生致敏。
我们回顾性地评估了 17 例 DRESS 患者的斑贴试验（PT）数据和临床资料，这些患者在 DRESS 期间使用了其他致敏原的抗生素。
9 例（53%）PT 对抗生素阳性：6 例青霉素组，3 例头孢菌素（包括 1 例对万古霉素也阳性）。考虑到 8 例 PT 对抗生素阴性的患者，7 例曾接触过氟喹诺酮类药物。4 例再次进行斑贴试验，3 例在 2-5 年后仍对抗生素呈阳性。2 例 PT 阳性的患者意外再次接触抗生素，出现了伴有全身症状的斑丘疹。
DRESS 或其前驱期接触抗生素可能会增强对抗生素的致敏，这一点通过 PT 阳性得到了证实。多年后 PT 对抗生素再次呈阳性，以及重新接触后再激活，支持 DRESS 中 T 细胞介导的抗生素过敏是一种特异性反应。
