ÖZET

Giriş:

Sefazolin, özellikle stafilokoklar ve streptokoklar gibi Gram-pozitif ajanlara karşı etkili olan birinci kuşak bir sefalosporindir. Bu dar spektruma rağmen cerrahi profilakside önemlidir. Bu çalışmada doğrulanmış β-laktam alerjisi olan hastalarda sefazolin tolere edilebilirliğini değerlendirmeyi amaçladık.

Yöntemler:

Sefazolin alerjisi şüphesiyle sefazolin alerjisi tetkiki yapılan hastalar (Grup 1) ve sefazolin dışında β-laktam alerjisi olduğu doğrulanmış çocuklar (Grup 2) çalışmaya dahil edildi. Suçlu ilaç ve penisilin ile deri testi ve/veya provokasyon testi pozitifliği belirlenerek β-laktam alerjisi doğrulandı. Tüm hastalara sefazolin deri testi yapıldı. Deri testi negatif olan tüm hastalara provokasyon testi de uygulandı.

Bulgular:

Toplam 35 hasta değerlendirildi. Bunlardan 11’inde sefazolin kullandıktan sonra şüpheli alerjik reaksiyon öyküsü vardı. Kalan 24’ünde doğrulanmış bir β-laktam alerjisi vardı. Üç hastada sefazolin alerjisi doğrulandı. Şüpheli reaksiyonları olan 11 çocuktan 1’inde sefazolin alerjisini doğruladık. Doğrulanmış β-laktam alerjisi olan hastalardan 2’si sefazoline de alerjikti ve her ikisinin de birden fazla β-laktam antibiyotiğe alerjisi vardı.

Sonuç:

Betalaktam alerjisi olan hastaların çoğu sefazolini tolere edebilir. Bulgularımız, birden fazla β-laktam antibiyotiğe ve penisiline doğrulanmış alerjisi olan çocukların sefazoline de duyarlı olduğunu göstermektedir. Seçici sefazolin alerjisi olan çocukların yan zincire duyarlı olması beklenir. Sefazolin kullanımına karar vermede ayrıntılı bir öykü ve kapsamlı bir alerjik değerlendirme çok önemlidir.

References

Romano A, Valluzzi RL, Gaeta F. Cephalosporin allergy. İn: Khan DA, Banerji A editors. Drug Allergy Testing. St. Louis, Missouri; Elsevier; 2018:115–28.

Romano A, Valluzzi RL, Caruso C, Zaffiro A, Quaratino D, Gaeta F. Tolerability of cefazolin and ceftibuten in patients with IgE-mediated aminopenicillin Allergy. J Allergy Clin Immunol Pract 2020;8:1989-93.

Lam PW, Tarighi P, Elligsen M, Nathens AB, Riegert D, Tarshis J et al. Impact of the allergy clarification for cefazolin evidence-based prescribing tool on receipt of preferred perioperative prophylaxis: An interrupted time series study. Clin Infect Dis 2020;71:2955-7.

Atanaskovic-Markovic M. What is new in beta-lactam allergy in children? Pediatr Allergy Immunol 2021;32:219-22.

Zagursky RJ, Pichichero ME. Cross-reactivity in b-Lactam Allergy. J Allergy Clin Immunol Pract 2018;6:72-81.

Wyles CC, Hevesi M, Osmon DR, Park MA, Habermann EB, Lewallen DG, et al. 2019 John Charnley Award: Increased risk of prosthetic joint infection following primary total knee and hip arthroplasty with the use of alternative antibiotics to cefazolin: the value of allergy testing for antibiotic prophylaxis. Bone Joint J 2019;101-B(6_Supple_B):9-15.

Blumenthal KG, Ryan EE, Li Y, Lee H, Kuhlen JL, Shenoy ES. The impact of a reported penicillin allergy on surgical site infection risk. Clin Infect Dis 2018;66:329-36.

Blumenthal KG, Lu N, Zhang Y, Li Y, Walensky RP, Choi HK. Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ 2018;361:k2400.

Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, Blanca-Lopez N, et al. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy 2016;71:149-61.

Romano A, Atanaskovic-Markovic M, Barbaud A, Bircher AJ, Brockow K, Caubet JC, et al. Towards a more precise diagnosis of hypersensitivity to beta-lactams - an EAACI position paper. Allergy 2020;75:1300-15.

Solensky R, Phillips EJ. Drug Allergy. In: Burks WA, Holgate ST, O’Hehir RE, Broide DH, Bacharier LB, Khurana Hershey GK, Peebles RS editors. Middleton’s Allergy: Principles and Practice. Ninth Edition. Elsevier; 2020:1261-81.

Romano A, Gaeta F, Valluzzi RL, Zaffiro A, Caruso C, Quaratino D. Natural evolution of skin-test sensitivity in patients with IgE-mediated hypersensitivity to cephalosporins. Allergy 2014;69:806-9.

Romano A, Gaeta F, Valluzzi RL, Maggioletti M, Zaffiro A, Caruso C, et al. IgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of alternative cephalosporins. J Allergy Clin Immunol 2015;136:685-91.

Uyttebroek AP, Decuyper II, Bridts CH, Romano A, Hagendorens MM, Ebo DG, et al. Cefazolin hypersensitivity: Toward optimized diagnosis. J Allergy Clin Immunol Pract 2016;4:1232-6.

Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, et al. Skin test concentrations for systemically administered drugs -- an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy 2013;68:702-12.

Brockow K, Romano A. Skin tests in the diagnosis of drug hypersensitivity reactions. Curr Pharm Des 2008;14:2778-91.

Atanaskovic-Markovic M, Gomes E, Cernadas JR, du Toit G, Kidon M, Kuyucu S, et al. Diagnosis and management of drug-induced anaphylaxis in children: An EAACI position paper. Pediatr Allergy Immunol 2019;30:269-76.

Stone CA Jr, Trubiano JA, Phillips EJ. Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins. J Allergy Clin Immunol Pract 2021;9:435-44.

Almeida JP, Lopes A, Campos Melo A, Pereira Santos MC, Pereira Barbosa M. Selective hypersensitivity to cefazolin and contribution of the basophil activation test. Eur Ann Allergy Clin Immunol 2017;49:84-7.

Blanca-Lopez N, Jimenez-Rodriguez TW, Somoza ML, Gomez E, Al-Ahmad M, Perez-Sala D, et al. Allergic reactions to penicillins and cephalosporins: diagnosis, assessment of cross-reactivity and management. Expert Rev Clin Immunol 2019;15:707-21.

Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet 2019;393:183-98.

Picard M, Robitaille G, Karam F, Daigle JM, Bédard F, Biron É, et al. Cross-reactivity to cephalosporins and carbapenems in penicillin-allergic patients: Two systematic reviews and meta-analyses. J Allergy Clin Immunol Pract 2019;7:2722-38.

Wurpts G, Aberer W, Dickel H, Brehler R, Jakob T, Kreft B, et al. Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the German Society of Allergology (AeDA), German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Austrian Society for Allergology and Immunology (ÖGAI), and the Paul-Ehrlich Society for Chemotherapy (PEG). Allergol Select 2020;4:11-43.

Khan DA, Banerji A, Bernstein JA, Bilgicer B, Blumenthal K, Castells M, et al. Cephalosporin allergy: Current understanding and future challenges. J Allergy Clin Immunol Pract 2019;7:2105-14.

Vyles D, Macy E. Self-reported beta-lactam intolerance: not a class effect, dangerous to patients, and rarely allergy. Expert Rev Anti Infect Ther 2019;17:429-35.

Torres MJ, Adkinson NF Jr, Caubet JC, Khan DA, Kidon MI, Mendelson L, et al. Controversies in drug allergy: Beta-lactam hypersensitivity testing. J Allergy Clin Immunol Pract 2019;7:40-5.

Yuson C, Kumar K, Le A, Ahmadie A, Banovic T, Heddle R, et al. Immediate cephalosporin allergy. Intern Med J 2019;49:985-93.

Betalaktam Alerjisi Olan Çocuklarda Sefazolin Profilaksisi Güvenliği

ÖZET

References