Romano Antonino, Valluzzi Rocco Luigi, Caruso Cristiano, Zaffiro Alessandra, Quaratino Donato, Gaeta Francesco
IRCCS Oasi Maria S.S., Troina, Italy & Fondazione Mediterranea G.B. Morgagni, Catania, Italy.
Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy.
J Allergy Clin Immunol Pract. 2020 Jun;8(6):1989-1993.e2. doi: 10.1016/j.jaip.2020.02.025. Epub 2020 Mar 4.
Side-chain similarities or identities constitute the predominant factor for cross-reactivity between penicillins and cephalosporins, whereas differences in the side-chain structure seem to account for the absence of such cross-reactivity.
We sought to assess the cross-reactivity between penicillins and 2 cephalosporins (ie, cefazolin and ceftibuten) that have side chains different from those of penicillins, as well as to evaluate the possibility of using these cephalosporins in penicillin-allergic subjects.
We conducted a prospective study of 131 consecutive subjects who had suffered 170 immediate reactions (mostly anaphylaxis) to penicillins and had positive skin test results to at least 1 penicillin reagent. All patients underwent skin tests with cefazolin and ceftibuten. Patients with negative results were challenged with them.
One participant had positive skin test results to cefazolin and ceftibuten, as well as to all other reagents tested, including aztreonam and carbapenems. All 129 subjects who underwent challenges with cefazolin and ceftibuten tolerated them. One subject refused cephalosporin challenges.
Subjects with an IgE-mediated hypersensitivity to penicillins could be treated with cephalosporins such as cefazolin and ceftibuten, which are among the cephalosporins that have side-chain determinants different from those of penicillins. Nevertheless, in patients with such hypersensitivity who need these alternative β-lactams, pretreatment skin tests are advisable because of the possibility of coexisting sensitivities or, much less frequently, of a sensitivity to an antigenic determinant of the common β-lactam ring.
侧链的相似性或一致性是青霉素和头孢菌素之间交叉反应的主要因素，而侧链结构的差异似乎是不存在这种交叉反应的原因。
我们试图评估青霉素与两种侧链与青霉素不同的头孢菌素（即头孢唑林和头孢布烯）之间的交叉反应，并评估在青霉素过敏患者中使用这些头孢菌素的可能性。
我们对131例连续的患者进行了一项前瞻性研究，这些患者对青霉素发生了170次速发型反应（大多为过敏反应），且对至少1种青霉素试剂皮肤试验结果呈阳性。所有患者均接受了头孢唑林和头孢布烯的皮肤试验。结果阴性的患者接受了激发试验。
1名参与者对头孢唑林、头孢布烯以及所有其他检测试剂（包括氨曲南和碳青霉烯类）的皮肤试验结果均为阳性。所有129例接受头孢唑林和头孢布烯激发试验的患者均耐受。1名患者拒绝头孢菌素激发试验。
对青霉素有IgE介导的超敏反应的患者可以使用头孢唑林和头孢布烯等头孢菌素进行治疗，这些头孢菌素的侧链决定簇与青霉素不同。然而，对于有这种超敏反应且需要这些替代β-内酰胺类药物的患者，由于可能存在共存的敏感性，或者更罕见的是对常见β-内酰胺环抗原决定簇的敏感性，建议进行预处理皮肤试验。
