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Penicillin Allergy
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Page 1: Penicillin Allergy

Penicillin Allergy

Page 3: Penicillin Allergy

Penicillin Allergy: Overview

• Penicillin antibiotics are the most common cause of drug allergies

• An allergic reaction that occurs when your body’s immune system overreacts to penicillin antibiotics

• The most common adverse effects noted with the penicillins

Page 4: Penicillin Allergy

Penicillin Allergy: Overview

• may occur with any dosage form of penicillin.• Allergy to one penicillin exposes the patient to

a greater risk of reaction if another is given.• However, the occurrence of an untoward

effect does not necessarily imply repetition on subsequent exposures.

Page 5: Penicillin Allergy

Manifestations of allergy to penicillins

Maculo-papular rash

Anaphylaxis

Stevens-Johnson syndrome

Exfoliative dermatitis

Serum Sickness

Vasculitis

Brochospasm

Fever

Urticarial rashHigh

Frequency

Low

Page 6: Penicillin Allergy

Manifestations of allergy to penicillins

Maculo-papular rash

Anaphylaxis

Stevens-Johnson syndrome

Exfoliative dermatitis

Serum Sickness

Vasculitis

Brochospasm

Fever

Urticarial rash

• Sudden, severe hypotension

• Brochoconstriction

Sudden Death !!!

Page 7: Penicillin Allergy

Manifestations of allergy to penicillins

Maculo-papular rash

Anaphylaxis

Stevens-Johnson syndrome

Exfoliative dermatitis

Serum Sickness

Vasculitis

Brochospasm

Fever

Urticarial rash เป็�นผื่��นมากจนทำ าให้�เก�ดลอกทำ��งตั�ว

Page 8: Penicillin Allergy

Manifestations of allergy to penicillins

Maculo-papular rash

Anaphylaxis

Stevens-Johnson syndrome

Exfoliative dermatitis

Serum Sickness

Vasculitis

Brochospasm

Fever

Urticarial rash ผื่�วห้น�งอ�กเสบ

Page 9: Penicillin Allergy

Manifestations of allergy to penicillins

Maculo-papular rash

Anaphylaxis

Stevens-Johnson syndrome

Exfoliative dermatitis

Serum Sickness

Vasculitis

Brochospasm

Fever

Urticarial rash ผื่��นลมพิ�ษ

Page 10: Penicillin Allergy

Manifestations of allergy to penicillins

Maculo-papular rash

Anaphylaxis

Stevens-Johnson syndrome

Exfoliative dermatitis

Serum Sickness

Vasculitis

Brochospasm

Fever

Urticarial rash ผื่��นแดง, ตั !มน"นแดง

Page 11: Penicillin Allergy

Manifestations of allergy to penicillins

Maculo-papular rash

Anaphylaxis

Stevens-Johnson syndrome

Exfoliative dermatitis

Serum Sickness

Vasculitis

Brochospasm

Fever

Urticarial rash

The most serious hypersensitivity reactions

• Anaphylaxis• Angioedema (ห้น�งตัา, ป็าก

บวม)

Page 12: Penicillin Allergy

Hapten Carrier Complex

Mechanism of penicillin allergy

Penicillin

Hapten = Low molecular weight substances that are able to produce

an allergic response•By themselves they are unable to induce antibody formation.

Break down

Penicillin Isomers

Covalent bond tissue&plasma proteins

Immune Response

Page 13: Penicillin Allergy

Table1: Classification of Penicillin Reactions

Classification Time of onset Mediators Clinical Signs

1. Early Reaction

•Type I Hypersensitivity

15-30 mins IgE mediated •Anaphylaxis

•Angioedema

•Urticaria

•Type II Hypersensitivity

Varies min to hour

IgG, complement •Hemolytic anemia

•Granulocytopenia

•Type III

Hypersensitivity

Varies, 4-8 hr IgG, IgM immune complexes

•Serum Sickness

•Vasculitis

2. Late Reaction

•Type IV

Hypersensitivity

24-72 hr Cytokines activate Tc cells causing direct cellular damage

Contact dermatitis

•Idiopathic Usually >72 hrs

Maculopapular rash

is observed occasionally in pharmacists, nurses, and physicians

who prepare penicillin solutions

Page 14: Penicillin Allergy

Type I:Immediate/Anaphylactic Hypersensitivity

Hapten Carrier

Complex

ป็ฏิ�ก�ริ�ยาภู"ม�แพิ�เฉี(ยบพิล�นเริ(ยกว!า Anaphylaxis ซึ่*�งม(อาการิ• ลมพิ�ษ• ความด�นโลห้�ตัตั �า• ค�น• Angioedema

Page 15: Penicillin Allergy

Type II: Antibody-dependent cytotoxic Hypersensitivity

Hapten Carrier Complex

IgG IgM

• Soluble antigens that can attach to cell membranes

3 mechanism1. Opsonization/ Phagocytosis2. Antibody dependent cell cytotoxicity

(ADCC)1. Classical Complement Pathway

Destruction of affected cell/tissuesโดยเฉพาะเซลล�เม็ ดเล�อดทำ�าให้�เกิ�ด• Immune hemolytic anemia (เม็ ดเล�อดแดงแตกิ)•Thrombocytopenia (เกิล ดเล�อดต��า)•Granulocytopenia (เม็ ดเล�อดขาวต��า)

Penicillin Isomers

Covalent bond tissue&

Plasma proteins

Page 16: Penicillin Allergy

Type III: Immune complex mediated hypersensitivity

IgG IgM

Page 17: Penicillin Allergy

Type III: Immune complex mediated hypersensitivity

Immune Complex deposited

in BV cell wall, tissues

1. Complement activation (Classical Pathway)

2. Activation of neutrophil/ Phagocytosis Tissue damage

4. Activation of platelet

3. Activation of mast cell by immune complex&by c3a, c5a (anaphylatoxin)

Neutrophil recruitment

Destructive enzymes And reactive oxygen

species

HistamineLeukotriene

Vasodilation

Microthrombi

Tissue Necrosis

Page 18: Penicillin Allergy

Type III: Immune complex mediated hypersensitivity

Immune Complex deposited

in BV cell wall, tissues

1. Complement activation (Classical Pathway)

2. Activation of neutrophil/ Phagocytosis Tissue damage

4. Activation of platelet

3. Activation of mast cell by immune complex&by c3a, c5a (anaphylatoxin)

อาการิแพิ�ยา penicillin • Serum Sickness • Vasculitis• Fever• Rash

Page 19: Penicillin Allergy

Management of drug allergy

• Identify most likely drugs (based on history).• Avoidance of identified drug or suspected drugs is essential.• Perform allergy skin tests (if available).• Avoid potential cross-reacting drugs (e.g. avoid Cephalosporins in penicillin-

allergic individuals).• Use alternative medications, if at all possible.• Desensitize to implicated drug, if this drug is deemed essential.(เริ��มให้�จาก dose

ตั �าๆภูายใตั�การิด"แลของแพิทำย/)