Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio.
Ann Allergy Asthma Immunol. 2020 Jun;124(6):589-593. doi: 10.1016/j.anai.2020.02.007. Epub 2020 Feb 20.
Hypersensitivity reactions (HSRs) to tetracyclines and the related compound, tigecycline, can limit the use of these medications and compromise optimal patient care. Despite this, there is little discussion in the literature describing the presentation of these reactions or guiding clinicians on the management of these reactions in adult and pediatric patients.
To describe the clinical features, optimal diagnostic approach, and management of HSRs to tetracyclines.
Patients with reactions to tetracyclines at our institution from 2011 to 2019 were identified by retrospective chart review. Skin testing protocols were designed for each antibiotic. Graded challenge and desensitization procedures were devised based on medical history, skin testing results when available, and need for readministration.
The HSRs to tetracyclines, their workup, and management are described for 10 patients, aged 7 to 68 years. Our skin testing protocols for doxycycline, minocycline, and tigecycline described herein had good negative predictive value. When skin testing was negative and the initial reaction was not severe, graded challenge to the culprit drug was performed. Using the included procedures, 3 patients were desensitized to oral doxycycline, 3 to oral minocycline, and 2 to intravenous tigecycline. All the desensitizations were successful.
Once identified, HSRs to tetracyclines can be further evaluated with skin testing and graded challenge and managed in appropriate cases with desensitization. These procedures can facilitate first-line therapy for patients who require tetracyclines but developed hypersensitivity reactions.
对四环素类药物和相关化合物替加环素的过敏反应（HSR）可能会限制这些药物的使用，并影响患者的最佳治疗效果。尽管如此，文献中很少有关于这些反应表现的讨论，也没有指导临床医生如何管理成人和儿科患者中这些反应的信息。
描述四环素类药物 HSR 的临床特征、最佳诊断方法和管理策略。
通过回顾性病历审查，确定了 2011 年至 2019 年期间我院发生的四环素类药物过敏反应患者。为每种抗生素设计了皮肤测试方案。根据病史、可用的皮肤测试结果以及重新给药的需要，制定了分级挑战和脱敏程序。
描述了 10 例年龄 7 至 68 岁的患者的四环素类药物 HSR、检查和治疗情况。我们在此描述的用于多西环素、米诺环素和替加环素的皮肤测试方案具有良好的阴性预测值。当皮肤测试为阴性且初始反应不严重时，对可疑药物进行分级挑战。使用包括的程序，有 3 例患者对口服多西环素、3 例患者对口服米诺环素、2 例患者对静脉用替加环素进行了脱敏。所有脱敏均成功。
一旦确定，可通过皮肤测试和分级挑战进一步评估四环素类药物的 HSR，并在适当的情况下进行脱敏治疗。这些程序可以为需要使用四环素类药物但发生过敏反应的患者提供一线治疗方法。
