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Anapylaxis?
Iwona Poziomkowska- Gęsicka MD PhD
• Shock after use cefuroxyme,
• Asthma
• Hay fever
• received with aim of selection of safe
antibiotic
M 41 y.o Appointment
History
Anapylaxis:
III 2007; urticaria after licking teaspoon with drop
Cefuroxyme (15 min past)
Identification of factor
History
• V 2007, it was ill and received orally Cefuroxyme,
15 min past 1 dose: pruritus, erythema, runny nose,
lack of space in throat, dyspnoe, loss of
consciousness
– stay in hospital
Identification of factor
History
• X 2007;
with reason of ill of ear received the ointment -
Cefuroxyme, after 10 min.: pruritus, erythema,dyspnoe,
shiver
•History in the past:
Tolerate cefuroxyme (Zinnat) in II 2006
Identification of factor
History
From 2003r. – Asthma treatment: GCS – inh.
β2-agonist , antyhistamines.
From 2006r. – Hay fever- Immunotherapy : 70% grass
30% weeds (motherword).
• Child – food allergy
• Grandpa - asthma
Family history
In examination and spirometry – without deviation
First Diagnosis
• Amaphylaxis III0 on Cefuroxyme
• Asthma
• Hay fever
Hypersensitivity
• Skin prick tests positive with pollen: Tree, weeds, grass, Alternaria i Cladosporium, cat, dog, DM .
Hypersensitivity allergic or not
• Skin prick tests & intradermal test with penicyllin- negative.
Hypersensitivity allergic or not
TestsBadana substancja prick
tests
1:1
intradermal tests (histamina 6x6)
1:1000 1:100 1:10 1:1
Płyn kontrolny – – – – –
Histamina 5 X X X X
Testarpen – – – – –
Penicylina kryst. 5x105 IE/ml
– – – – –
Ampicylina 25mg/ml – – – – –
Amoxicillin 25mg/ml – – – – –
Ceftazydym – – – – –
Ceftybuten – – – – –
Ceftriakson 2x2 – 6x4 6x5 9x8
Cefuroksym 15x16mm + pseudopodia
not made
(diameter of wheal mm after 20 min)
po 24 h brak odczynów opóźnionych w miejscach wykonania prób skórnych
Hypersensitivity allergic or not
Hypersensitivity allergic or not
Hypersensitivity allergic or not
• Specyfic IgE aganst penicyllin - negative
RAST
Hypersensitivity allergic or not
• Anaphylaxis I i III degree,
hypersensitivity IgE – dependent on
cefuroxyme.
• Asthma
• Hay fever.
Final diagnosis
Allergic IgE mediated hypersensitivity
Complete dose Results
penicyllin cryst. 1 mln negative
amoxicillin 1000mg negative
ceftybuten 400mg negative
Selection of safe antibioticOral provocation tests.
Selection of safe antibiotic
Tests
Badana substancja prick tests
1:1
intradermal tests
1:1000 1:100 1:10 1:1
Płyn kontrolny – – – – –
Histamina 4 X X X 5x6
Testarpen – – – – –
Penicylina kryst. 5x105 IE/ml
– – – – –
Ampicylina 25mg/ml – – – – –
Amoxicillin 25mg/ml – – – – –
Ceftazydym – – 5x5 6x7 Nie wykonano
Ceftybuten 5x5 Nie wykonano
(diameter of wheal mm after 20 min)
po 24 h brak odczynów opóźnionych w miejscach wykonania prób skórnych
Tests after provocation
Selection of safe antibiotic
• After provocation tests: skin pric & intradermal with
penicyllin- negative.
• After provocation tests: skin pric & intradermal with
ceftazydym, ceftybuten - positive, conversion of skin
reaction.
Selection of safe antibiotic
RecommendationRecommendation• The prohibition of applying the cefuroxyme
• Contrindication use ceftriakson, ceftybuten &
ceftazydym.
• It the tolerance of crystalline penicillin was
confirmed was as well as the amoxicillin in test of
provocation, these penicillins were not observed
after provocation the conversion of skin reactions.
• Treatment: asthma and hay fever.
Allergic IgE mediated hypersensitivity