青霉素及β内酰胺类抗生素过敏的管理

‘Allergic’ or immune-mediated reactions in the form of urticaria and serum sickness began to emerge in the early 1940s when penicillin was introduced as a useful therapeutic agent. The first report is attributed to Lyons who found that 5.7% of US army personnel treated with penicillin for surgical infections suffered from urticaria. The first review on allergic reactions to penicillin was published in 1946. These ‘allergic’ or immune-mediated reactions are currently termed‘hypersensitivity’ reactions according to the Coombs and Gell classification.

Immunological responses to penicillin and other beta-lactam antibiotics can be broadly classified as ‘immediate’ and ‘non-immediate’ based on the temporal association of onset of symptoms following drug administration. While ‘immediate’ responses are IgEmediated and generally occur within minutes to 1 h following exposure to the last dose, ‘non-immediate’ reactions are non-IgE-mediated and manifest generally more than 60 min to several days after last dose administration. The latter group is heterogeneous with respect to clinical manifestations and underlying immunological mechanisms. An extended classification of non-immediate drug-induced type IV reactions was introduced by Pichler and colleagues. The longer the interval between the onset of reaction and time of drug intake, the less probable the reaction is IgEinduced, reviewed in. In some cases, however, it is not possible to classify the reaction according only to this time frame.