Pricktest als Provokation – schwere anaphylaktische Reaktion auf Hauttests mit Ceftriaxon bei beruflicher Exposition

Zusammenfassung

Es werden zwei Patienten vorgestellt, die wegen eines Asthma bronchiale bei beruflichem Kontakt mit Ceftriaxon abgeklärt wurden. Bei beiden trat innerhalb von Minuten nach Anlegen eines Pricktests mit Ceftriaxon eine adrenalinpflichtige, anaphylaktische Reaktion auf. Systemische Reaktionen auf Hauttests mit Betalaktamantibiotika sind relativ selten, sie können auch bei Patienten mit vorausgegangenen milden Symptomen wie Urtikaria oder beruflichen Kontaktallergien auf Betalaktame auftreten. Als Risikofaktoren werden schwere Anaphylaxien in der Anamnese und ein kurzes Reaktionsintervall genannt. Eine korrekte Durchführung der Hauttests mit Titration und eine adäquate Überwachung sind zu beachten.

Abstract

Two patients are presented who were evaluated for bronchial asthma due to occupational exposure to ceftriaxone. In both, an anaphylactic reaction occurred within minutes after application of a prick test with ceftriaxone, requiring epinephrine administration. Systemic reactions to skin tests with beta-lactam antibiotics are relatively rare and may occur in patients with antecedent mild symptoms such as urticaria or occupational contact allergies to beta-lactams. Risk factors include a history of severe anaphylaxis and a short reaction interval. It is imperative to pay attention to the correct performance of skin tests with titration and adequate monitoring of the patient.

Publication History

Article published online:
25 August 2021

• Literatur

• 1 Wurpts G, Aberer W, Dickel H. 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 (OGAI), and the Paul-Ehrlich Society for Chemotherapy (PEG). Allergol Select 2020; 4: 11-43 DOI: 10.5414/ALX02104E.
• 2 Co Minh HB, Bousquet PJ, Fontaine C. et al. Systemic reactions during skin tests with beta-lactams: a risk factor analysis. J Allergy Clin Immunol 2006; 117: 466-468 DOI: 10.1016/j.jaci.2005.10.020.
• 3 Liccardi G, DʼAmato G, Canonica GW. et al. Systemic reactions from skin testing: literature review. J Investig Allergol Clin Immunol 2006; 16: 75-78
• 4 Filipe P, Almeida RS, Rodrigo FG. Occupational allergic contact dermatitis from cephalosporins. Contact Dermatitis 1996; 34: 226 DOI: 10.1111/j.1600-0536.1996.tb02186.x.
• 5 Foti C, Bonamonte D, Trenti R. et al. Occupational contact allergy to cephalosporins. Contact Dermatitis 1997; 36: 104-105 DOI: 10.1111/j.1600-0536.1997.tb00423.x.
• 6 Häusermann P, Bircher AJ. Immediate and delayed hypersensitivity to ceftriaxone, and anaphylaxis due to intradermal testing with other beta-lactam antibiotics, in a previously amoxicillin-sensitized patient. Contact Dermatitis 2002; 47: 311-312
• 7 Antunes J, Silva R, Pacheco D. et al. Occupational contact allergy to cephalosporins. Dermatol Online J 2011; 17: 13
• 8 Classen A, Fuchs T. Occupational allergy to β-lactam antibiotics. Allergo J Int 2015; 24: 54-57 DOI: 10.1007/s40629-015-0047-3.
• 9 Kim JE, Kim SH, Jin HJ. et al. IgE Sensitization to Cephalosporins in Health Care Workers. Allergy Asthma Immunol Res 2012; 4: 85-91 DOI: 10.4168/aair.2012.4.2.85.
• 10 Tadokoro K, Niimi N, Ohtoshi T. et al. Cefotiam-induced IgE-mediated occupational contact anaphylaxis of nurses; case reports, RAST analysis, and a review of the literature. Clin Exp Allergy 1994; 24: 127-133 DOI: 10.1111/j.1365-2222.1994.tb00208.x.
• 11 Gaspar-Marques J, Finelli E, Martins PC. et al. Piperacillin-tazobactam anaphylaxis: a rare cause of occupational disease. Eur Ann Allergy Clin Immunol 2018; 50: 89-91 DOI: 10.23822/EurAnnACI.1764-1489.29.
• 12 Bircher AJ. Drug Allergens. In: John SM, Duus Johansen J, Rustemeyer T. et al. Kanerva’s Occupational Dermatology. 3rd. Aufl. Berlin, New York: Springer; 2020: 559-578
• 13 Diaz Angulo S, Szram J, Welch J. et al. Occupational asthma in antibiotic manufacturing workers: case reports and systematic review. J Allergy (Cairo) 2011; 2011: 365683 DOI: 10.1155/2011/365683.
• 14 Kruszewski J, Bant A. [Occupational penicillin allergy as an example of chronic recurring anaphylaxis]. Wiad Lek 2001; 54: 116-121
• 15 Merget R, Sander I, Fartasch M. et al. Occupational generalized urticaria and anaphylaxis after inhalation of cefuroxime in a nurse. Am J Ind Med 2018; 61: 261-266 DOI: 10.1002/ajim.22788.
• 16 Siracusa A, Folletti I, Gerth van Wijk R. et al. Occupational anaphylaxis – an EAACI task force consensus statement. Allergy 2015; 70: 141-152 DOI: 10.1111/all.12541.
• 17 Goossens A, Geebelen J, Vander Hulst K. et al. Pharmaceutical and Cosmetic Industries. In: John SM, Duus JohansenJ, Rustemeyer T. et al. Kanerva’s Occupational Dermatology. 3rd. Aufl. Berlin, New York: Springer; 2020: 2203-2219 DOI: 10.1007/978-3-319-68617-2_180
• 18 Reddy R, Maibach HI, Belsito DV. Healthcare Workers. In: John SM, Duus Johansen J, Rustemeyer T. et al. Kanerva’s Occupational Dermatology. 3rd. Aufl. Berlin, New York: Springer; 2020: 2061-2071 DOI: 10.1007/978-3-319-68617-2_161
• 19 Alonso Díaz de Durana MD, Fernández-Rivas M, Casas ML. et al. Anaphylaxis during negative penicillin skin prick testing confirmed by elevated serum tryptase. Allergy 2003; 58: 159 DOI: 10.1034/j.1398-9995.2003.00056_2.x.
• 20 Aurich S, Schuurmann M, Simon JC. et al. Anaphylactic shock caused by intradermal testing with cefuroxime. J Dtsch Dermatol Ges 2017; 15: 668-670 DOI: 10.1111/ddg.13246.
• 21 Dreborg S. The risk of general reactions to skin prick testing (SPT). Allergy 1996; 51: 60-61 DOI: 10.1111/j.1398-9995.1996.tb00012.x.
• 22 Koshak EA. Could a routine skin test to penicillin lead to fatal anaphylaxis?. East Mediterr Health J 2000; 6: 526-531
• 23 Novembre E, Bernardini R, Bertini G. et al. Skin-prick-test-induced anaphylaxis. Allergy 1995; 50: 511-513 DOI: 10.1111/j.1398-9995.1995.tb01187.x.
• 24 Pitsios C, Dimitriou A, Kontou-Fili K. Allergic reactions during allergy skin testing with food allergens. Eur Ann Allergy Clin Immunol 2009; 41: 126-128
• 25 Rudzki E, Rebandel P. Occupational contact urticaria from penicillin. Contact Dermatitis 1985; 131: 192
• 26 Riezzo I, Bello S, Neri M. et al. Ceftriaxone Intradermal Test-Related Fatal Anaphylactic Shock: A Medico-Legal Nightmare. Allergy 2010; 65: 130-131 DOI: 10.1111/j.1398-9995.2009.02088.x.
• 27 Aurich S, Schuurmann M, Simon JC. et al. Anaphylactic shock caused by intradermal testing with cefuroxime. J Dtsch Dermatol Ges 2017; 15: 668-670 DOI: 10.1111/ddg.13246T.