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Aktuelle Dermatologie 2022; 48(06): 255-259
DOI: 10.1055/a-1543-0663
Fehler und Irrtümer in der Dermatologie

Isolierte Zungenschwellung nach Penicillin und negative Allergieabklärung – alles in Butter?

Isolated Tongue Swelling after Penicillin and Negative Allergy Workup – All Done and Dusted?
Kathrin Scherer Hofmeier
1   Allergologie, Dermatologie, Kantonsspital Aarau, Schweiz
,
Andreas J. Bircher
2   Allergologie, Dermatologie, Universitätsspital Basel, Schweiz
3   Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
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Zusammenfassung

Penicilline können alle Arten spezifischer Immunreaktionen nach der erweiterten Coombs- und Gell-Klassifikation auslösen und zählen zu den häufigsten Ursachen unerwünschter Arzneimittelreaktionen. Das diagnostische Armamentarium umfasst neben den verschiedenen Hauttests den Nachweis spezifischer IgE gegen allergene Determinanten am Betalaktam-Molekül und ggf. zelluläre Aktivierungstests. Im Fall negativer Ergebnisse bei den genannten Tests kann ggf. noch die Toleranz im Rahmen eines Provokationstestes nachgewiesen werden. Die Sensitivität der diagnostischen Tests ist – mit Ausnahme des Provokationstests – aber limitiert, und falsch negative Tests sind möglich. Wir präsentieren zwei Fälle mit einer isolierten Zungenschwellung nach Gabe von Amoxicillin bei vollständig negativem, wiederholtem allergologischen Work-up. Bei beiden Patienten konnte die Überempfindlichkeit nur mit einer Reexposition nachgewiesen werden.

Abstract

Penicillins may cause all kinds of specific immune reactions according to the extended Coombs and Gell classification and are among the most frequent elicitors of adverse drug reactions. In addition to various skin tests, the diagnostic armamentarium includes the detection of specific IgE against allergenic determinants at the betalactam structure and potentially performance of cellular activation assays. In the case of negative results of these tests, tolerance can be proven by challenge tests. Sensitivity of those diagnostic tests is – with the exception of the challenge tests – limited and falsely negative tests are possible. We present 2 cases of isolated tongue swelling after single dose amoxicilline with repeated completely negative allergy workup. Sensitization was proven in both patients only by oral challenge – with a severe and potentially life-threatening reaction in one patient.



Publication History

Article published online:
14 January 2022

© 2022. Thieme. All rights reserved.

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