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Allergo Journal

, Volume 28, Issue 5, pp 19–51 | Cite as

S2k-Leitlinie: Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit

Leitlinie der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAKI) in Zusammenarbeit mit dem Ärzteverband Deutscher Allergologen (AeDA), der Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA), der Deutschen Kontaktallergiegruppe (DKG), der Österreichischen Gesellschaft für Allergologie und Immunologie (ÖGAI) und der Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG)
  • Gerda WurptsEmail author
  • Werner Aberer
  • Heinrich Dickel
  • Randolf Brehler
  • Thilo Jakob
  • Burkhard Kreft
  • Vera Mahler
  • Hans F. Merk
  • Norbert Mülleneisen
  • Hagen Ott
  • Wolfgang Pfützner
  • Stefani Röseler
  • Franziska Ruëff
  • Helmut Sitter
  • Cord Sunderkötter
  • Axel Trautmann
  • Regina Treudler
  • Bettina Wedi
  • Margitta Worm
  • Knut Brockow
Leitlinie
  • 257 Downloads

Zusammenfassung

Die vorliegende Leitlinie (S2k) zur Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit wurde von den deutschen allergologischen Fachverbänden und der österreichischen allergologischen Fachgesellschaft sowie der Paul-Ehrlich-Gesellschaft für Chemotherapie im Konsens nach den Kriterien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erarbeitet.

Betalaktamantibiotika (BLA) wie Penicilline und Cephalosporine sind die Substanzgruppe, welche am häufigsten Arzneimittelallergien auslöst. Die anamnestische Angabe einer vermuteten Allergie übersteigt jedoch in ihrer Häufigkeit deutlich die bestätigten Fälle. Die große Anzahl vermuteter BLA-Allergien hat einen großen Einfluss, unter anderem auf die Behandlungsqualität des einzelnen Patienten sowie die Kosten für die Allgemeinheit.

Allergien auf BLA beruhen auf unterschiedlichen immunologischen Mechanismen und äußern sich häufig als makulopapulöse Exantheme, aber auch als Anaphylaxien; daneben finden sich verschiedene Sonderformen der Arzneimittelallergien. Allen BLA gemeinsam ist der Betalaktamring. Eingeteilt werden die BLA in verschiedene Klassen: die Penicilline, Cephalosporine, Carbapeneme, Monobactame und Betalaktamaseinhibitoren mit unterschiedlichen Strukturmerkmalen. Von großer klinischer Bedeutung ist die Kenntnis über mögliche Kreuzreaktivitäten. Eine Unverträglichkeit gegenüber allen BLA tritt nur bei einem geringen Prozentsatz aller Allergiker auf, häufiger sind Kreuzreaktivitäten bei Seitenkettenähnlichkeiten wie Aminopenicillinen und Aminocephalosporinen oder auch den Methoxyiminocephalosporinen. Das Bild insgesamt ist jedoch komplex und bedarf weiterer Studien zur Aufklärung.

Die Diagnostik besteht üblicherweise aus vier Bausteinen: der Anamnese, der Labordiagnostik, Hauttestungen, welchen ein großer Stellenwert zukommt, sowie der Arzneimittelprovokationstestung. Das Vorgehen der Diagnostik, aber auch im akuten Bedarfsfall der BLA-Gabe ist an der Patientenhistorie und dem Einzelfall orientiert. Ergänzend zu den bisherigen Erkenntnissen besteht auch hier weiterer Studienbedarf.

Die Durchführung der allergologischen Diagnostik bei Verdacht auf eine BLA-Überempfindlichkeit ist zugunsten einer guten medizinischen Versorgung des Einzelnen, aber auch aufgrund der immensen Auswirkungen mutmaßlicher BLA-Allergien für die Allgemeinheit dringend zu empfehlen.

Schlüsselwörter

Betalaktamantibiotika Allergie Penicillin Cephalosporin Arzneimittelüberempfindlichkeit 

Abkürzungsverzeichnis

AGEP

Akute generalisierte exanthematische Pustulose

AMP

Ampicillin

AX

Amoxicillin

BAT

Basophilenaktivierungstest

BL

Betalaktame

BLA

Betalaktamantibiotikum/Betalaktamantibiotika

BP

Benzylpenicillin

BPO

Benzylpenicilloyl

BP-OL

Benzylpenicilloyl-octa-L-lysin

BP-OL

Benzylpenicilloyl-octa-L-lysin

CAST

Zellulärer Antigenstimulationstest; „cellular allergen stimulation test“

CAST-ELISA

„Cellular antigen stimulation test-enzyme linked immunosorbent assay“

CLV

Clavulansäure

DIHS

„Drug-induced hypersensitivity syndrome“

DPT

Arzneimittelprovokation; „drug provocation test“

DRESS

„Drug reaction with eosinophilia and systemic symptoms“

EEM

Erythema exsudativum multiforme

ELISpot

„Enzyme linked immunosorbent spot assay“

FDE

Fixes Arzneimittelexanthem

FEIA

Fluoreszenzimmunoassay

HFT

Histamin-Freisetzungstest

HSA

Humanes Serumalbumin

i.c.

Intrakutane Hauttestung

IgE

Immunglobulin E

IFN-γ

Interferon-gamma

IL

Interleukin

LTT

Lymphozytentransformationstest

MD(M)

Minordeterminaten(n-Mix), „minor determinant mixture“

MPE

Makulopapulöses Exanthem

MRSA

Methicillin-resistenter Staphylococcus aureus

NORA

Network of severe allergic reactions

NPV

Negativer prädiktiver Vorhersagewert

PA

„Penicillenic acid“

PPL

Benzylpenicilloyl-poly-L-Lysin

RAST

Radio-Allergo-Sorbent-Test

SDRIFE

„Symmetrical drug-related intertriginous and flexural exanthema“

sIgE

Spezifisches Immunglobulin E

SJS

Stevens-Johnson-Syndrom

TEN

Toxische epidermale Nekrolyse

VRE

Vancomycin-resistente Enterokokken

Supplementary material

15007_2019_1876_MOESM1_ESM.pdf (402 kb)
Abbildung 1: Betalaktamantibiotika — Strukturformeln/R1- und R2-Seitenkette

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Gerda Wurpts
    • 1
    Email author
  • Werner Aberer
    • 2
  • Heinrich Dickel
    • 3
  • Randolf Brehler
    • 4
  • Thilo Jakob
    • 5
  • Burkhard Kreft
    • 6
  • Vera Mahler
    • 7
    • 8
  • Hans F. Merk
    • 1
  • Norbert Mülleneisen
    • 9
  • Hagen Ott
    • 10
  • Wolfgang Pfützner
    • 11
  • Stefani Röseler
    • 1
  • Franziska Ruëff
    • 12
  • Helmut Sitter
    • 13
  • Cord Sunderkötter
    • 6
  • Axel Trautmann
    • 14
  • Regina Treudler
    • 15
  • Bettina Wedi
    • 16
  • Margitta Worm
    • 17
  • Knut Brockow
    • 18
  1. 1.Klinik für Dermatologie und Allergologie, Aachener Comprehensive Allergy CenterUniversitätsklinik der RWTH AachenAachenDeutschland
  2. 2.Klinik für DermatologieMedizinische Universität GrazGrazÖsterreich
  3. 3.Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-HospitalUniversitätsklinikum der Ruhr-Universität BochumBochumDeutschland
  4. 4.Klinik für HautkrankheitenUniversitätsklinikum MünsterMünsterDeutschland
  5. 5.Klinik für Dermatologie und AllergologieUniversitätsklinikum Gießen und MarburgStandort GießenDeutschland
  6. 6.Klinik für Dermatologie und VenerologieUniversitätsklinikum Halle (Saale)Halle (Saale)Deutschland
  7. 7.Paul-Ehrlich-InstitutLangenDeutschland
  8. 8.HautklinikUniversitätsklinikum ErlangenErlangenDeutschland
  9. 9.Lungen- und AllergiezentrumLeverkusenDeutschland
  10. 10.Pädiatrische Dermatologie und AllergologieKinder- und Jugendkrankenhaus Auf der BultHannoverDeutschland
  11. 11.Klinik für Dermatologie und AllergologieUniversitätsklinikum Gießen und MarburgStandort MarburgDeutschland
  12. 12.Klinik und Poliklinik für Dermatologie und Allergologie, Allergie ZentrumLudwig-Maximilians-Universität MünchenMünchenDeutschland
  13. 13.Institut für Chirurgische ForschungPhilipps-Universität MarburgMarburgDeutschland
  14. 14.Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Allergiezentrum MainfrankenUniversitätsklinikum WürzburgWürzburgDeutschland
  15. 15.Klinik für Dermatologie, Venerologie und Allergologie und Leipziger Interdisziplinäres Centrum für Allergologie — LICA-CACUniversität LeipzigLeipzigDeutschland
  16. 16.Klinik für Dermatologie, Allergologie und Venerologie, Comprehensive Allergy CenterMedizinische Hochschule HannoverHannoverDeutschland
  17. 17.Klinik für Dermatologie, Venerologie und AllergologieCharité-Universitätsmedizin Berlin, Allergie-Centrum-Charité (ACC)BerlinDeutschland
  18. 18.Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität MünchenMünchenDeutschland

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