engleski

Anaphylaxis after intradermal testing with cefuroxime axetil

Background: A 16-year-old boy with a positive family drug allergy history came to our hospital for planned drug hypersensitivity testing. According to history data one year ago our patient was, for the first time in his life, treated with cefuroxime for acute sinusitis. Fifteen minutes after intake of the first tablet he developed weakness and after half an hour nausea, repetitive vomiting, paresthesia of the head and tong and generalized urticaria. In between he ate sandwich. He was admitted to the local hospital and treated for anaphylaxis. His discharge diagnose was: Suspected allergy to cefuroxime, Anaphylaxis. The allergological workup done prior to drug hypersensitivity tests revealed no sensitization to nutritive or inhalational allergen or preservatives (Allergopharma, Reinbeck, Germany). His total IgE level was 10.6kU/l and specific serum IgE to penicilloyl g and v and amoxilloyl were negative (<0.35kU/L, Phadia ImmunoCap). Skin prick test and intradermal test with benzylpenicillin-polylisine (PPL) and minor determinant mixture (MDM) were negative. The tests were performed according to European Network for Drug Allergy (ENDA) recommendations. SPT with cefuroxime (2mg/ml) was also negative. Intradermal tests with cefuroxime was performed of the volar side of the forearm with histamine 1:10000, sodium chloride 0.9% and cefuroxime (2mg/ml), 1:100, 1:10 and 1:1, under latex free conditions. Ten minutes after intradermal testing with cefuroxime the patient developed anaphylaxis characterized with recurrent vomiting, paresthesia of the head and limbs, throat itching, generalized urticaria and abdominal cramps. He was treated with adrenaline intramuscularly, antihistamine and intravenous corticoids. The symptoms disappeared after approximately one hour. Tryptase level measured two and a half hour later was normal (5.37μg/l). On further allergological workup we performed oral challenge with amoxicillin, combination of amoxicillin and clavulanic acid, and representatives of other generations of cefalosporins, cefalin, ceftriaxone, cefepim and all of them were negative. Anaphylaxis during intradermal testing occurs rarely. Ceforuxime is a second generation semisynthetic cephalosporin that is widely used for treatment of respiratory tract infections. Both the sodium salt for parenteral administration and the acetyloxy ethyl ester for oral use are generally well tolerated. We found no previously published data on anaphylaxis during intradermal testing with cefuroxime, which makes this case unusual. His previously data were suggestive for IgE mediated reaction, not obligatory to cefuroxime, regarding to information about first intake of ceforuxime ever. This case points out that all intradermal tests should be performed with caution, under strict supervision for at least one hour after performed test.

cefuroxime, children, Anaphylaxis

nije evidentirano