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Aktuelle Dermatologie 2022; 48(06): 260-266
DOI: 10.1055/a-1539-2221
Fehler und Irrtümer in der Dermatologie

Kleine Ursache – große Wirkung: Spättyp-Hauttests mit Medikamenten als Auslöser von disseminierten Rezidivexanthemen

Small Cause – Big Effect: Delayed-type Skin Tests with Drugs as Trigger of Disseminated Relapse Exanthems
Andreas J. Bircher
1   Allergologie, Universitätsspital Basel, Schweiz
2   Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
,
Dagmar Jamiolkowski
1   Allergologie, Universitätsspital Basel, Schweiz
,
Esther H. Steveling-Klein
1   Allergologie, Universitätsspital Basel, Schweiz
,
Kathrin Scherer Hofmeier
1   Allergologie, Universitätsspital Basel, Schweiz
3   Allergologie, Dermatologie, Kantonsspital Aarau, Schweiz
,
Carlos Morales Mateluna
1   Allergologie, Universitätsspital Basel, Schweiz
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Zusammenfassung

Es werden zwei Patienten vorgestellt, die wegen eines streuenden allergischen Kontakt- bzw. Arzneimittelexanthems auf Budesonid bzw. Antibiotika abgeklärt wurden. Bei beiden trat innerhalb einiger Stunden nach Anlegen eines Epikutantests mit Budesonid bzw. Intradermaltests mit Amoxicillin eine stark positive Hauttestreaktion sowie ein Exanthem auf. Beim ersten Patienten lag eine Sensibilisierung auf die kreuzreagierenden Moleküle Budesonid und Amcinonid, bei der zweiten Patientin eine ausgeprägte Überempfindlichkeit auf Aminopenicilline vor. Aufflammphänomene (Flare-ups) sind v. a. aus der Kontaktallergologie bekannt, können aber auch bei der Abklärung von allergischen Arzneimittelexanthemen auftreten. Systemische Reaktionen vom verzögerten Typ auf Spättyp-Hauttests mit Medikamenten sind relativ selten, können aber eine erhebliche Morbidität bewirken. Verschiedene Formen von Aufflammphänomenen in der Allergologie werden diskutiert.

Abstract

Two patients are presented, who were investigated because of a disseminated allergic contact or drug exanthema on budesonide and antibiotics, respectively. Both patients showed a strong positive skin test reaction and an exanthema within a few hours after a patch test with budesonide and an intradermal test with amoxicillin, respectively. The first patient had sensitization to the cross-reacting molecules budesonide and amcinonide, and the second patient had marked hypersensitivity to aminopenicillins. Flare-ups are known mainly from contact allergy but may also occur in the work-up of allergic drug exanthema. Delayed-type systemic reactions to delayed-type skin tests with drugs are relatively rare but can cause significant morbidity. Various forms of flare-up phenomena in allergology are discussed.



Publication History

Article published online:
17 January 2022

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