β-内酰胺类抗菌药物临床交叉过敏反应的发生机制及美国相关处理流程介绍

Mechanism of Clinical Cross Allergy Reaction of β-lactam Antibiotics and Introduction of Related Treatment Processes in USA

目的:了解β-内酰胺类抗菌药物在临床使用中发生交叉过敏反应的机制,为临床合理用药提供参考。方法:结合笔者在美国伊利诺伊大学芝加哥分校(UIC)附属医院进修期间的学习心得,同时根据美国拉什大学医学中心对β-内酰胺类抗菌药物过敏史者的安全用药管理经验,总结β-内酰胺类抗菌药物发生交叉过敏反应的机制,并介绍美国UIC附属医院对β-内酰胺类抗菌药物过敏患者的处理流程。结果:β-内酰胺类抗菌药物发生交叉过敏反应的主要原因是由于药物之间存在相同或相似的侧链,人体内免疫球蛋白E通过识别这些侧链而产生交叉过敏反应。美国UIC附属医院对β-内酰胺类抗菌药物过敏患者的处理流程,包括对患者是否有β-内酰胺类抗菌药物使用指征进行评估,根据评估结果进行规范的青霉素皮试,并采用谨慎渐进式流程用药和快速诱导药物耐受流程进行抗感染治疗。结论:美国UIC附属医院对β-内酰胺类抗菌药物交叉过敏反应患者的处理方法,可为国内临床药师处理可疑β-内酰胺类抗菌药物过敏史者,尤其是针对孕妇、儿童等特殊人群提供新的思路。

OBJECTIVE： To investigate the mechanism of cross allergy reaction during the application of β-lactam antibiotics, and to provide reference for rational drug use in clinic. METHODS： Based on study experience of author in UIC and its affiliated hospital during advanced study, according to the experience of drug use safety management in patients allergic to β-lactam antibiot- ics from Rush University Medical Center, the mechanism of cross allergy reaction during the application of β-lactam antibiotics was summarized, and the disposal procedure for patients allergic to β-lactarn antibiotics in the Affiliated Hospital of UIC was intro- duced. RESULTS： The principal reason for cross allergy reaction induced by β-lactam antibiotics were same or similar side chains between drugs. Cross allergy reaction occurred when IgE recognized these side chains. The disposal procedure for patients allergic to β-lactam antibiotics in the Affiliated Hospital of UIC included that the indication of β-lactam use was evaluated; standard penicil- lin skin testing according to evaluation results, anti-infection treatment by Grade challenge β-lactam antibiotics and course and rap- id drug tolerance induction. CONCLUSIONS： The disposal method for patients allergic to β-lactam antibiotics in the Affiliated Hos- pital of UIC can provide new thought for domestic clinical pharmacists in rational drug use among the patiens with reported aller- gies to special group as pregnant women, children.