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青霉素过敏
Penicillin Allergy


Mariana Castells ... 其他 • 2019.12.12
相关阅读
• 更新版过敏反应治疗指南 • 用口服试验对报告青霉素过敏的低危患者进行评价

1928年,亚历山大·弗莱明爵士发现一种青霉属真菌的活性成分能够杀死培养皿中的细菌,他将该活性成分命名为青霉素。1945年,弗莱明、弗洛里和钱恩因“发现青霉素及其对多种传染病的疗效”而共同获得诺贝尔生理学或医学奖。自20世纪50年代初以来,青霉素挽救了数百万人的生命,包括儿童、孕妇,以及脓毒症、脑膜炎、心内膜炎及其他危及生命的感染患者。青霉素仍然是预防梅毒母婴传播的唯一推荐治疗药物。

1945年报道了第1例与青霉素相关的过敏反应,而1968年世界卫生组织的一份报告指出,该过敏反应的死亡率为0.002% 1。并无数据提示过敏反应的发生率在过去60年间有所增加,而且有令人信服的证据表明青霉素的致敏作用会随着时间的推移而消失2。口服、皮下注射和静脉注射后可观察到青霉素暴露引起的过敏反应3。1957年一项覆盖美国827家医院的全国性调查估计,在青霉素投入使用后的10年内,共发生1,000例与青霉素相关的死亡1,4。此外,自1950年以来,青霉素的应用增多,我们据此估算出从1965年至1968年,美国每年有300人因使用青霉素而死于过敏性休克,但这些数据无法证实1。在医学文献中,有一篇综述是关于1951—1965年的151例使用青霉素导致的死亡,其结果表明无性别差异1;其中50%以上的人在25~65岁,44%有呼吸道感染,28%之前患过敏或哮喘,69%曾使用过青霉素,其中36%曾对该药物产生反应。在85%的病例中,青霉素给药与症状发生之间的平均间隔不到15分钟,大多数患者在青霉素给药后1小时内死亡。





作者信息

Mariana Castells, M.D., Ph.D., David A. Khan, M.D., and Elizabeth J. Phillips, M.D.
From Brigham and Women’s Hospital, Boston (M.C.); UT Southwestern Medical Center, Dallas (D.A.K.); and Vanderbilt University Medical Center, Nashville (E.J.P.). Address reprint requests to Dr. Castells at Brigham and Women’s Hospital, 60 Fenwood Rd., Rm. 5002N, Boston, MA 02115, or at mcastells@bwh.harvard.edu.

 

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