세팔로스포린계 항생제에 대한 Skin Test 현황 분석
Analysis on Results of Cephalosporin Skin Testing and Developments of Hypersensitivity Reactions
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Although allergic reactions to cephalosporins have been estimated to be infrequent,these agents can induce severe or life-threatening IgE-mediated reactions for some cases. Unlike penicillin, cephalosporin haptens and determinants have not yet been fylly identified. Therefore, usually the whole antibiotics are usually used as skin test reagents, diluted at nonirritating concentration in attempts to detect the presence of IgE antibodies to cephalosporins. Skin testing with the reagents above has not yet been proven to be reliable for predicting hypersensitivity reactions. Thus, the usefulness of skin testing before administration of the drugs is controversial. In Samsung Medical Center (SMC), skin tests have been generally performed before administrating the cephalosporins. Therefore, this study is aimed to investigate current statuses of cephalosporin skin testing and supplementary clinical evidences. From May 1 to May 18, 2012, 1462 cases of cephalosporin skin tests, performed at inpatient setting were included and electronic medical records (EMR) of them were retrospectively reviewed. 13 injected cephalosporins were involved. Cephalosporin-induced reactions were distinguished based on three causality assessment criteria, and IgE-mediated reactions were defined as reactions developed within 72 hours after administration of the drugs. Among the total of 1462 skin tests performed, 21 cases were reported to be skin test positive and 1441 cases were reported to be skin test negative. In 21 cases of positive skin tests, all the patients didn't receive cephalosporins according to the skin test guidelines in SMC. Among skin test negative cases, the patients were challenged with the drugs in only 1413 cases. And it was found that 32 (2.26%) of them presented possible IgE-mediated reactions despite the negative skin test results. Symptoms of IgE-mediated reactions were usually mild and self-limited or subsided promptly without stopping administration of the drugs; no cases of life-threatening anaphylactic reactions had occurred. Only in 5 cases, cephalosporins were being discontinued for treating allergic reactions, and 2 (0.14%) of them were assessed to be specifically highly probable. In conclusion, the present study described the prevalence of cephalosporin skin test results and suggested the incidence of false negative reactions in skin test-negative group. Unfortunately, we could not obtain the information on false positive reactions in the skin test-positive group. If it was feasible to administer drugs after positive skin tests and follow up on whether the hypersensitivity reactions really occur, additional conclusions could be derived. However, in respect of patient's consents, it may still be difficult to administer drugs in those patients. Therefore, at this point of time skin tests have been performed routinely, the reported data would help to enhance the less known clinical information on cephalosporin skin tests.
Abstract
Although allergic reactions to cephalosporins have been estimated to be infrequent,these agents can induce severe or life-threatening IgE-mediated reactions for some cases. Unlike penicillin, cephalosporin haptens and determinants have not yet been fylly identified. Therefore, usually the whole antibiotics are usually used as skin test reagents, diluted at nonirritating concentration in attempts to detect the presence of IgE antibodies to cephalosporins. Skin testing with the reagents above has not yet been proven to be reliable for predicting hypersensitivity reactions. Thus, the usefulness of skin testing before administration of the drugs is controversial. In Samsung Medical Center (SMC), skin tests have been generally performed before administrating the cephalosporins. Therefore, this study is aimed to investigate current statuses of cephalosporin skin testing and supplementary clinical evidences. From May 1 to May 18, 2012, 1462 cases of cephalosporin skin tests, performed at inpatient setting were included and electronic medical records (EMR) of them were retrospectively reviewed. 13 injected cephalosporins were involved. Cephalosporin-induced reactions were distinguished based on three causality assessment criteria, and IgE-mediated reactions were defined as reactions developed within 72 hours after administration of the drugs. Among the total of 1462 skin tests performed, 21 cases were reported to be skin test positive and 1441 cases were reported to be skin test negative. In 21 cases of positive skin tests, all the patients didn't receive cephalosporins according to the skin test guidelines in SMC. Among skin test negative cases, the patients were challenged with the drugs in only 1413 cases. And it was found that 32 (2.26%) of them presented possible IgE-mediated reactions despite the negative skin test results. Symptoms of IgE-mediated reactions were usually mild and self-limited or subsided promptly without stopping administration of the drugs; no cases of life-threatening anaphylactic reactions had occurred. Only in 5 cases, cephalosporins were being discontinued for treating allergic reactions, and 2 (0.14%) of them were assessed to be specifically highly probable. In conclusion, the present study described the prevalence of cephalosporin skin test results and suggested the incidence of false negative reactions in skin test-negative group. Unfortunately, we could not obtain the information on false positive reactions in the skin test-positive group. If it was feasible to administer drugs after positive skin tests and follow up on whether the hypersensitivity reactions really occur, additional conclusions could be derived. However, in respect of patient's consents, it may still be difficult to administer drugs in those patients. Therefore, at this point of time skin tests have been performed routinely, the reported data would help to enhance the less known clinical information on cephalosporin skin tests.
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