Daniel Jefferson, Thippaiah Rashmitha, Christopher Devasahayam J
Department of Pulmonary Medicine, Christian Medical College Vellore, Vellore, IND.
Cureus. 2025 May 24;17(5):e84729. doi: 10.7759/cureus.84729. eCollection 2025 May.
This series presents two cases of anaphylaxis following the administration of beta-lactam antibiotics, piperacillin-tazobactam, and cefotaxime in patients who had previously shown negative skin test results. A 32-year-old woman with no history of allergies developed anaphylaxis 15 minutes after receiving piperacillin-tazobactam, despite a negative intradermal test. Similarly, a 48-year-old woman with no prior allergic response experienced anaphylaxis within 10 minutes of cefotaxime administration even after a negative intradermal test. Both patients were successfully treated with epinephrine, fluids, and corticosteroids with close monitoring of further complications. These cases highlight the limitations of preemptive skin testing for antibiotics, a practice still commonly followed in certain healthcare settings in India, despite growing concerns about its predictive reliability and lack of standardization. Unstandardized methods of skin testing, as commonly practiced in India, have poor sensitivity and are unreliable for predicting drug-related anaphylaxis. Furthermore, even small intravenous test doses can trigger severe anaphylactic reactions, underscoring the need for caution during antibiotic allergy testing. According to the European Academy of Allergy and Clinical Immunology (EAACI) and the American Academy of Allergy, Asthma, and Immunology (AAAAI) guidelines, skin testing is recommended only in suspected cases of antibiotic allergy, with diagnostic algorithms tailored to the nature of the reaction. However, these guidelines are not universally followed, particularly in regions where standardized testing resources and training are limited. These cases emphasize the need for standardized indications and protocols for skin testing in India, along with the adaptation of international guidelines to suit India's unique clinical and healthcare context, potentially serving as a model for other resource-limited countries that face similar challenges.
本系列报告了两例既往皮肤试验结果呈阴性的患者在使用β-内酰胺类抗生素哌拉西林-他唑巴坦和头孢噻肟后发生过敏反应的病例。一名无过敏史的32岁女性在接受哌拉西林-他唑巴坦治疗15分钟后发生过敏反应，尽管皮内试验结果为阴性。同样，一名既往无过敏反应的48岁女性在使用头孢噻肟后10分钟内发生过敏反应，即使皮内试验结果也是阴性。两名患者均通过肾上腺素、补液和糖皮质激素成功治疗，并密切监测是否有进一步并发症。这些病例凸显了抗生素预防性皮肤试验的局限性，尽管对其预测可靠性和缺乏标准化的担忧日益增加，但在印度的某些医疗环境中，这种做法仍普遍存在。印度普遍采用的非标准化皮肤试验方法灵敏度低，对于预测药物相关过敏反应并不可靠。此外，即使是小剂量静脉试验也可能引发严重过敏反应，这突出了抗生素过敏试验时谨慎操作的必要性。根据欧洲变态反应和临床免疫学会（EAACI）以及美国变态反应、哮喘与免疫学会（AAAAI）的指南，仅在疑似抗生素过敏病例中推荐进行皮肤试验，并根据反应性质制定诊断算法。然而，这些指南并未得到普遍遵循，尤其是在标准化检测资源和培训有限的地区。这些病例强调了印度需要标准化的皮肤试验适应症和方案，以及调整国际指南以适应印度独特的临床和医疗环境，这可能为面临类似挑战的其他资源有限国家提供一个范例。
