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