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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.

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Presentation on theme: "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."— Presentation transcript:

1 Anapylaxis? Iwona Poziomkowska- Gęsicka MD PhD

2 Shock after use cefuroxyme, Asthma Hay fever received with aim of selection of safe antibiotic M 41 y.o Appointment

3 History Anapylaxis: III 2007; urticaria after licking teaspoon with drop Cefuroxyme (15 min past) Identification of factor

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5 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

6 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

7 History From 2003r. – Asthma treatment: GCS – inh. β 2 -agonist, antyhistamines. From 2006r. – Hay fever- Immunotherapy : 70% grass 30% weeds (motherword).

8 Child – food allergy Grandpa - asthma Family history

9 In examination and spirometry – without deviation

10 First Diagnosis Amaphylaxis III 0 on Cefuroxyme Asthma Hay fever Hypersensitivity

11 Skin prick tests positive with pollen: Tree, weeds, grass, Alternaria i Cladosporium, cat, dog, DM. Hypersensitivity allergic or not

12 Skin prick tests & intradermal test with penicyllin- negative. Hypersensitivity allergic or not

13 Tests Badana 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. 5x10 5 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

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16 Specyfic IgE aganst penicyllin - negative RAST Hypersensitivity allergic or not

17 Anaphylaxis I i III degree, hypersensitivity IgE – dependent on cefuroxyme. Asthma Hay fever. Final diagnosis Allergic IgE mediated hypersensitivity

18 Complete doseResults penicyllin cryst. 1 mlnnegative amoxicillin 1000mgnegative ceftybuten 400mgnegative Selection of safe antibiotic Oral provocation tests. Selection of safe antibiotic

19 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. 5x10 5 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

20 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

21 Recommendation 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

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