Cefixime is allergic to shock?Be careful!Allergicity

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Cefixime is allergic to shock?Be careful!Allergicity

2022-01-14 06:05:49 50 ℃

Sharing one case cephalosporin skin test negative, the occurrence of cases of anaphylactic shock infusion.

Case reproduction

Basic information: The patient, female, 41 years old. Because of "repeated coughing, shortness of breath with chest tightness 2 more than a month, increased cough with five days' admission to 2021-09-29. 3 months ago after catching a cough, shortness of breath, had oral cefixime anti-infection treatment, no significant improvement in symptoms, but no rash and other allergic symptoms. Previous history of bronchial asthma. Chest CT suggest lung infection.

Admission diagnosis: a bronchial asthma, non-critically; 2 pneumonia; pulmonary nodules 3.

Treatment plan: improve the examination after admission, consider the patient with acute exacerbation of bronchial asthma, pneumonia exist, to "cefotaxime sodium 2.0 bid intravenous anti-infective" treatment, and to oral montelukast sodium, ambroxol, doxofylline intravenous, inhalation and the like budesonide asthma control.

After occurrence: 2021-09-29 15:05, at about 5 minutes cefotaxime 2.0 g intravenous infusion, patients skin rash, with itching, flushing, chest tightness, shortness of breath significantly. Nurses suspend delivery immediately and report the doctor in charge, blood pressure 81/58 mmHg, heart rate of 91 beats / min, breathing 22 times / min.

After the rescue:

Consider anaphylactic shock, 15:06 start rescue, I Venturi oxygen mask, ECG, dexamethasone 5 mg bolus, intravenous methylprednisolone 40 mg, 0.5 mg of epinephrine intramuscularly, compound sodium chloride rehydration, promethazine 25 mg intramuscularly. After treatment still dyspnea, skin irritation with the body, the blood pressure rose to 120/80 mmHg, the oxygen saturation of 99%.

15:15, severe abdominal pain patients, to 0.5 mg of atropine intramuscularly, ICU and requested urgent consultation, to 0.3 mg of epinephrine intramuscularly Again, dexamethasone 5 mg bolus, 1.0 g of calcium gluconate injection bolus. Treated, chest tightness, shortness of breath gradually improved patient, maintain blood pressure at 110/80 mmhg, oxygen saturation 99%, skin irritation subsided, abdominal pain and numbness improved.

Specific treatment as follows:

It is observed that no subsequent allergic symptoms. Follow-up was symptomatic and supportive treatment after hospital discharge.

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Skin test negative, why anaphylactic shock?

The patients had no history of drug allergy, before admission oral treatment cefixime, cefotaxime infusion oxime done before the skin test is negative.

So, why is there still negative skin test anaphylactic shock? After cephalosporin skin test is also necessary to continue to do it?

We might as well look at the "skin test guidelines in the β-lactam antibiotics (2021 edition)" in the recommendations:

Negative skin test can not completely rule out the possibility of an allergic reaction. Some drugs can inhibit skin reactions, leading to false negative results, it should ask the recent history of skin test before treatment and stopping the drug may interfere with the skin test results when conditions permit. Even if the skin test is negative, we need to use close observation of drug use, allergic reactions and make emergency preparations.

As to whether cephalosporin skin test needs to be done, the following two suggestions:

1. do not recommend routine skin test before using cephalosporins: cephalosporin administered before routine skin test without sufficient evidence to support evidence-based medicine for clinical predictive value of an allergic reaction, most of the instructions of cephalosporin antibiotics, "clinical use of antibiotics guiding principles" and "People's Republic of China Pharmacopoeia clinical guide" cephalosporin drugs were not required before routine skin test.

2. The following cases only need a skin test:

A history of penicillin or cephalosporin clear Ⅰ type (immediate) in patients with a history of allergies. As such patients clinically used cephalosporin indeed necessary, and with professionals, emergency conditions after obtaining informed consent of patients, selection and allergy medications cephalosporin side chain different skin test, which results a certain reference value ;

Drug description specifying the need for skin test. Drugs should be provided to further understand the mechanism of the drug caused by allergic reactions, skin test sensitivity, specificity, positive predictive value and negative predictive value, and ask for the skin test reagent;

A history of allergic diseases, such as allergic rhinitis, allergic asthma, atopic dermatitis, food allergies, and other drugs (non-β-lactam antibiotics) allergy, allergy cephalosporin occurrence probability is not higher than the general population, before cephalosporin you do not need routine skin test. But once these patients medication allergic reaction, symptoms may be more severe, was observed after treatment should be strengthened.

From this, is not currently recommended for routine skin test before using cephalosporins, such as patient case after really necessary to use cephalosporin, allergy medications should be used with different side chain of cephalosporin skin test.

Severe allergic reactions diagnostic criteria and emergency procedures

In order to facilitate everyone remember, we used 2 Zhang Siwei maps to illustrate the diagnostic criteria for severe allergic reactions and emergency procedures:

1. Clinical diagnostic criteria for severe allergic reactions

2. Process for treatment of a severe allergic reaction

Finally, we come back to do a survey, whether you are in the hospital has been canceled prescribed cephalosporin skin test?

Typesetting: Meichao

Figure title: Cool heroin station

references:

1. The principle of beta lactam antibacterial drug skin test guidelines (2021 edition) .2. Drug instructions.