1. Iwona Poziomkowska- Gęsicka MD PhD
Anapylaxis?
Iwona Poziomkowska- Gęsicka MD PhD

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

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

5. 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

6. 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

7. History
From 2003r. – Asthma treatment: GCS – inh. β2-agonist , antyhistamines. From 2006r. – Hay fever- Immunotherapy : 70% grass 30% weeds (motherword).

8. Family history
Child – food allergy
Grandpa - asthma

9. In examination and spirometry – without deviation

10. Amaphylaxis III0 on Cefuroxyme
Hypersensitivity
First Diagnosis
Amaphylaxis III0 on Cefuroxyme
Asthma
Hay fever

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

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

13. Hypersensitivity allergic or not
Tests
(diameter of wheal mm after 20 min)
Badana substancja
prick tests
1:1
intradermal tests (histamina 6x6)
1:1000
1:100
1:10
Płyn kontrolny –
Histamina 5 X
Testarpen
Penicylina kryst. 5x105 IE/ml
Ampicylina mg/ml
Amoxicillin mg/ml
Ceftazydym
Ceftybuten
Ceftriakson
2x2
6x4
6x5
9x8
Cefuroksym
15x16mm + pseudopodia
not
made
po 24 h brak odczynów opóźnionych w miejscach wykonania prób skórnych 13

14. Hypersensitivity allergic or not

15. Hypersensitivity allergic or not

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

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

18. Selection of safe antibiotic Oral provocation tests.
Complete dose
Results
penicyllin cryst.
1 mln
negative
amoxicillin
1000mg
ceftybuten
400mg

19. Selection of safe antibiotic
Tests after provocation
Tests
(diameter of wheal mm after 20 min)
Badana substancja
prick tests
1:1
intradermal tests
1:1000
1:100
1:10
Płyn kontrolny –
Histamina 4 X
5x6
Testarpen
Penicylina kryst. 5x105 IE/ml
Ampicylina mg/ml
Amoxicillin mg/ml
Ceftazydym
5x5
6x7
Nie wykonano
Ceftybuten
Nie
wykonano
po 24 h brak odczynów opóźnionych w miejscach wykonania prób skórnych 19

20. 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.

21. Allergic IgE mediated hypersensitivity
Recommendation
Allergic IgE mediated hypersensitivity
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.