疑似β-内酰胺类抗生素过敏的诊断程序指南 2020

2020-06-15 Allergol Select. 2020 May 28;4:11-43.

这份关于疑似β-内酰胺类抗生素(BLA)过敏的诊断程序指南是由德国和奥地利的过敏学专业协会，以及Paul-Ehrlich化疗协会根据德国科学医学会的标准，经过协商一致的程序编写的。青霉素类和

中文标题：

英文标题：

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics: Guideline of the German Society for Allergology and Clinical Immunology

发布机构：

发布日期：

2020-06-15

简要介绍：

这份关于疑似β-内酰胺类抗生素(BLA)过敏的诊断程序指南是由德国和奥地利的过敏学专业协会，以及Paul-Ehrlich化疗协会根据德国科学医学会的标准，经过协商一致的程序编写的。青霉素类和头孢菌素类等BLA代表了最常引发药物过敏的药物群体。然而，患者病历中疑似过敏的报告频率明显超过确诊病例的数量。大量的疑似BLA过敏病例对诸如患者个体接受治疗的质量和整个社会的成本都有很大影响。对BLA的过敏基于不同的免疫学机制，常表现为大疱性外伤，以及过敏性休克；另外还有一些不太常见的药物过敏反应的特殊临床表现。所有BLA都具有β-内酰胺环。BLA可分为不同的类别：青霉素类、头孢菌素类、碳青霉烯类、单内酰胺类、β-内酰胺酶抑制剂等不同化学结构的药物。对可能的交叉反应的了解具有相当重要的临床意义。而对常见的β-内酰胺环的过敏只发生在所有BLA过敏患者中的一小部分，而由于侧链相似而引起的交叉反应，如氨青霉素类和氨基头孢菌素类，甚至甲氧亚氨基头孢菌素类都比较常见。但总体情况复杂，其阐明可能需要进一步研究。BLA过敏的诊断程序通常由四个部分组成：患者病史、实验室诊断、皮肤试验（这一点尤为重要）和药物激发试验。诊断方法--即使是在需要施用BLA的情况下也是急性的--由患者病史和个案中的风险--收益比指导。在这里，再次需要进一步的研究来扩展目前的知识状态。对疑似BLA超敏者进行过敏测试，不仅是为了给患者提供良好的医疗服务，而且也是由于推定的BLA过敏对整个社会的巨大影响，因此迫切地建议进行过敏测试。

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