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S2k-Leitlinie: Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit

Leitlinie der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAKI) in Zusammenarbeit mit dem Ärzteverband Deutscher Allergologen (AeDA), der Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA), der Deutschen Kontaktallergiegruppe (DKG), der Österreichischen Gesellschaft für Allergologie und Immunologie (ÖGAI) und der Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG)

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An Erratum to this article was published on 13 September 2019

This article has been updated

Zusammenfassung

Die vorliegende Leitlinie (S2k) zur Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit wurde von den deutschen allergologischen Fachverbänden und der österreichischen allergologischen Fachgesellschaft sowie der Paul-Ehrlich-Gesellschaft für Chemotherapie im Konsens nach den Kriterien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erarbeitet.

Betalaktamantibiotika (BLA) wie Penicilline und Cephalosporine sind die Substanzgruppe, welche am häufigsten Arzneimittelallergien auslöst. Die anamnestische Angabe einer vermuteten Allergie übersteigt jedoch in ihrer Häufigkeit deutlich die bestätigten Fälle. Die große Anzahl vermuteter BLA-Allergien hat einen großen Einfluss, unter anderem auf die Behandlungsqualität des einzelnen Patienten sowie die Kosten für die Allgemeinheit.

Allergien auf BLA beruhen auf unterschiedlichen immunologischen Mechanismen und äußern sich häufig als makulopapulöse Exantheme, aber auch als Anaphylaxien; daneben finden sich verschiedene Sonderformen der Arzneimittelallergien. Allen BLA gemeinsam ist der Betalaktamring. Eingeteilt werden die BLA in verschiedene Klassen: die Penicilline, Cephalosporine, Carbapeneme, Monobactame und Betalaktamaseinhibitoren mit unterschiedlichen Strukturmerkmalen. Von großer klinischer Bedeutung ist die Kenntnis über mögliche Kreuzreaktivitäten. Eine Unverträglichkeit gegenüber allen BLA tritt nur bei einem geringen Prozentsatz aller Allergiker auf, häufiger sind Kreuzreaktivitäten bei Seitenkettenähnlichkeiten wie Aminopenicillinen und Aminocephalosporinen oder auch den Methoxyiminocephalosporinen. Das Bild insgesamt ist jedoch komplex und bedarf weiterer Studien zur Aufklärung.

Die Diagnostik besteht üblicherweise aus vier Bausteinen: der Anamnese, der Labordiagnostik, Hauttestungen, welchen ein großer Stellenwert zukommt, sowie der Arzneimittelprovokationstestung. Das Vorgehen der Diagnostik, aber auch im akuten Bedarfsfall der BLA-Gabe ist an der Patientenhistorie und dem Einzelfall orientiert. Ergänzend zu den bisherigen Erkenntnissen besteht auch hier weiterer Studienbedarf.

Die Durchführung der allergologischen Diagnostik bei Verdacht auf eine BLA-Überempfindlichkeit ist zugunsten einer guten medizinischen Versorgung des Einzelnen, aber auch aufgrund der immensen Auswirkungen mutmaßlicher BLA-Allergien für die Allgemeinheit dringend zu empfehlen.

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Change history

  • 13 September 2019

    In der „S2k-Leitlinie: Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit“ hat auf der ersten Seite die AWMF-Leitlinien-Registernummer gefehlt.

Abbreviations

AGEP:

Akute generalisierte exanthematische Pustulose

AMP:

Ampicillin

AX:

Amoxicillin

BAT:

Basophilenaktivierungstest

BL:

Betalaktame

BLA:

Betalaktamantibiotikum/Betalaktamantibiotika

BP:

Benzylpenicillin

BPO:

Benzylpenicilloyl

BP-OL:

Benzylpenicilloyl-octa-L-lysin

BP-OL:

Benzylpenicilloyl-octa-L-lysin

CAST:

Zellulärer Antigenstimulationstest; „cellular allergen stimulation test“

CAST-ELISA:

„Cellular antigen stimulation test-enzyme linked immunosorbent assay“

CLV:

Clavulansäure

DIHS:

„Drug-induced hypersensitivity syndrome“

DPT:

Arzneimittelprovokation; „drug provocation test“

DRESS:

„Drug reaction with eosinophilia and systemic symptoms“

EEM:

Erythema exsudativum multiforme

ELISpot:

„Enzyme linked immunosorbent spot assay“

FDE:

Fixes Arzneimittelexanthem

FEIA:

Fluoreszenzimmunoassay

HFT:

Histamin-Freisetzungstest

HSA:

Humanes Serumalbumin

i.c.:

Intrakutane Hauttestung

IgE:

Immunglobulin E

IFN-γ:

Interferon-gamma

IL:

Interleukin

LTT:

Lymphozytentransformationstest

MD(M):

Minordeterminaten(n-Mix), „minor determinant mixture“

MPE:

Makulopapulöses Exanthem

MRSA:

Methicillin-resistenter Staphylococcus aureus

NORA:

Network of severe allergic reactions

NPV:

Negativer prädiktiver Vorhersagewert

PA:

„Penicillenic acid“

PPL:

Benzylpenicilloyl-poly-L-Lysin

RAST:

Radio-Allergo-Sorbent-Test

SDRIFE:

„Symmetrical drug-related intertriginous and flexural exanthema“

sIgE:

Spezifisches Immunglobulin E

SJS:

Stevens-Johnson-Syndrom

TEN:

Toxische epidermale Nekrolyse

VRE:

Vancomycin-resistente Enterokokken

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Authors and Affiliations

  1. Klinik für Dermatologie und Allergologie, Aachener Comprehensive Allergy Center, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    Gerda Wurpts, Hans F. Merk & Stefani Röseler

  2. Klinik für Dermatologie, Medizinische Universität Graz, Graz, Österreich

    Werner Aberer

  3. Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland

    Heinrich Dickel

  4. Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland

    Randolf Brehler

  5. Klinik für Dermatologie und Allergologie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutschland

    Thilo Jakob

  6. Klinik für Dermatologie und Venerologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland

    Burkhard Kreft & Cord Sunderkötter

  7. Paul-Ehrlich-Institut, Langen, Deutschland

    Vera Mahler

  8. Hautklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland

    Vera Mahler

  9. Lungen- und Allergiezentrum, Leverkusen, Deutschland

    Norbert Mülleneisen

  10. Pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland

    Hagen Ott

  11. Klinik für Dermatologie und Allergologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Deutschland

    Wolfgang Pfützner

  12. Klinik und Poliklinik für Dermatologie und Allergologie, Allergie Zentrum, Ludwig-Maximilians-Universität München, München, Deutschland

    Franziska Ruëff

  13. Institut für Chirurgische Forschung, Philipps-Universität Marburg, Marburg, Deutschland

    Helmut Sitter

  14. Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Allergiezentrum Mainfranken, Universitätsklinikum Würzburg, Würzburg, Deutschland

    Axel Trautmann

  15. Klinik für Dermatologie, Venerologie und Allergologie und Leipziger Interdisziplinäres Centrum für Allergologie — LICA-CAC, Universität Leipzig, Leipzig, Deutschland

    Regina Treudler

  16. Klinik für Dermatologie, Allergologie und Venerologie, Comprehensive Allergy Center, Medizinische Hochschule Hannover, Hannover, Deutschland

    Bettina Wedi

  17. Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Allergie-Centrum-Charité (ACC), Berlin, Deutschland

    Margitta Worm

  18. Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Deutschland

    Knut Brockow

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  1. Gerda Wurpts
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  2. Werner Aberer
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  3. Heinrich Dickel
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  5. Thilo Jakob
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  6. Burkhard Kreft
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  7. Vera Mahler
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  10. Hagen Ott
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  14. Helmut Sitter
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  15. Cord Sunderkötter
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  16. Axel Trautmann
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  17. Regina Treudler
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  18. Bettina Wedi
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  19. Margitta Worm
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  20. Knut Brockow
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Corresponding author

Correspondence to Gerda Wurpts.

Additional information

Interessenkonflikt

Die Interessenkonflikterklärungen sind tabellarisch — neben dem Leitlinienreport — auf der entsprechenden Internetseite der AWMF zur „S2k-Leitlinie: Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit“ hinterlegt und dort abrufbar (www.awmf.org).

Der Verlag erklärt, dass die inhaltliche Qualität des Beitrags von zwei unabhängigen Gutachtern geprüft wurde. Werbung in dieser Zeitschriftenausgabe hat keinen Bezug zur CME-Fortbildung. Der Verlag garantiert, dass die CME-Fragen frei sind von werblichen Aussagen und keinerlei Produktempfehlungen enthalten. Dies gilt insbesondere für Präparate, die zur Therapie des dargestellten Krankheitsbildes geeignet sind.

Zitierweise

Wurpts G, Aberer W, Dickel H, Brehler R, Jakob T, Kreft B, Mahler V, Merk HF, Mülleneisen N, Ott H, Pfützner W, Röseler S, Ruëff F, Sitter H, Sunderkötter C, Trautmann A, Treudler R, Wedi B, Worm M, Brockow K. S2k Guideline: Diagnostics for suspected hypersensitivity to beta-lactam antibiotics. Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the Medical Association of German Allergologists (AeDA), German Society for Pediatric Allergology and Environmental Medicine (GPA), the Austrian Society for Allergology and Immunology (ÖGAI), and the Paul-Ehrlich Society for Chemotherapy (PEG). Allergo J Int 2019;28:121–51 https://doi.org/10.1007/s40629-019-0100-8

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Wurpts, G., Aberer, W., Dickel, H. et al. S2k-Leitlinie: Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit. Allergo J 28, 19–51 (2019). https://doi.org/10.1007/s15007-019-1876-z

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