Queen Elizabeth II Medical Centre, Department of Clinical Immunology, Sir Charles Gairdner Hospital, Pathwest, Nedlands, WA, Australia.
Medical School, University of Western Australia, Nedlands, WA, Australia.
Front Immunol. 2021 Feb 25;12:601954. doi: 10.3389/fimmu.2021.601954. eCollection 2021.
Current understanding of cross-reactivity in severe cutaneous adverse reactions to beta-lactam antibiotics is limited, thereby making recommendations for future prescribing difficult. The underlying immunopathogenesis of these reactions is not completely understood but involves interactions between small molecule drugs, T cells and HLA molecules. Historically, these reactions were considered to be specific to the inciting antibiotic and therefore likely to have minimal cross-reactivity. We assessed patients presenting with non-SJS/TEN severe cutaneous adverse reactions to a tertiary hospital drug allergy clinic. In our case series cross-reactivity or co-reactivity commonly occurred among the beta-lactam antibiotic class, however further research is required to investigate and understand patterns of cross-reactivity. Based on our experience we provide clinicians with a practical algorithm for testing for cross-reactivity in non-SJS/TEN severe cutaneous adverse reactions.
目前对于β-内酰胺类抗生素严重皮肤不良反应的交叉反应的认识有限，因此难以提出未来的用药建议。这些反应的潜在免疫发病机制尚不完全清楚，但涉及小分子药物、T 细胞和 HLA 分子之间的相互作用。从历史上看，这些反应被认为是特定于引发抗生素的，因此可能具有最小的交叉反应性。我们评估了在一家三级医院药物过敏诊所就诊的非 SJS/TEN 严重皮肤不良反应患者。在我们的病例系列中，β-内酰胺类抗生素之间经常发生交叉反应或共同反应，但是需要进一步的研究来调查和了解交叉反应的模式。基于我们的经验，我们为临床医生提供了一个用于非 SJS/TEN 严重皮肤不良反应中交叉反应性检测的实用算法。
