베타-락탐 항생제 알레르기: 일개 지역병원의 실제 임상

• Published in: The Korean journal of medicine Vol. 96; no. 1; pp. 42 - 47
• Main Authors: 김혜림, Hyerim Kim, 이재천, Jaechun Lee, 김세진, Sejin Kim
• Format: Journal Article
• Language: Korean
• Published: 대한내과학회 01.02.2021
• Subjects: Beta-lactams; Cephalosporins; Diagnostic tests; Drug hypersensitivity; Skin tests; 내과학; 베타-락탐 항생제; 아나필락시스; 약물 알레르기; 약물이상반응; 피부시험
• ISSN: 1738-9364; 2289-0769
• DOI: 10.3904/kjm.2021.96.1.42

목적: 베타-락탐 항생제는 약물이상반응의 흔한 원인 약물이다. 베타-락탐 알레르기는 처방 패턴에 따라 크게 다른 양상을 보이지만, 이에 대한 최근 국내 연구는 없다. 방법: 베타-락탐 항생제를 포함한 약물에 의한 약물이상반응 사례에서 베타-락탐 알레르기의 임상 양상을 후향적으로 조사하였다. 결과: 175명 중 약물이상반응의 원인약물로 베타-락탐 항생제가 가장 흔했다. 베타-락탐 알레르기가 확진된 79명(45.1%, 여자 53.2%, 나이 49 ± 14세) 중 두 명(2.5%)은 처방 약물조사로, 33명(41.8%)은 항생제 특이 IgE 항체 검사로, 29명(36.7%)은 피부시험으로, 15명(19.0%)은 약물유발 검사로 확진되었다. 소양감이 가장 흔하였고, 두드러기, 호흡곤란, 혈관부종, 저혈압 등의 증상 및 징후를 보였고, 대부분(61명, 77.3%) 투약 후 1시간 이내 발생하였다. 아나필락시스가 67%에서 발생하였고, 이 중 절반은 응급실을 방문하였다. 흔한 원인약물은 세파클러와 아목시실린 순이었다. 베타-락탐 항생제 이외에는 진통소염제(nonsteroidal anti-inflammatory drugs) 및 퀴놀론계 항생제가 흔한 원인약물로 확인되었다. 결론: 베타-락탐 항생제를 포함한 약물에 의해 발생하는 약물이상반응의 흔한 원인은 베타-락탐 항생제다. 응급실 방문을 요하는 아나필락시스가 흔히 발생하며, 다성분 처방으로 원인약물 확정에 어려움이 있다. Background/Aims: Beta-lactam (BL) antibiotics are widely prescribed for controlling bacterial infections and relevant culprits of adverse drug reactions (ADRs). BL allergy may vary according to prescription patterns within a given period of time. However, BL allergy in contemporary clinical practice has rarely been a focus of research. Methods: To investigate the clinical characteristics of BL allergy, subjects with ADRs to medicines, including BL antibiotics, were retrospectively reviewed. Results: Among the 175 enrolled subjects, BL antibiotics as culprits were confirmed in 79 (45.1%, female 53.2%, age 49 ± 14 years). Among the patients with confirmed BL allergy, only two (2.5%) were diagnosed via a prescription survey completed as part of multi-drug administration. The others were confirmed by serologic tests in 33 patients (41.8%), skin tests in 29 (36.7%), and drug provocation tests in 15 (19.0%). Regarding the symptoms and signs, onset within an hour of taking medicines was common (61 patients, 77.3%). Itchy skin was most common, followed by hives, rash, breathing difficulty, angioedema, and hypotension. Anaphylaxis occurred in 67%, and one-half (50.6%) of patients visited the emergency room. Cefaclor and amoxicillin were common BL culprits. Among others who did not have BL allergy, nonsteroidal anti-inflammatory drugs were found to be common culprits, followed by quinolones. Conclusions: BL allergy is common among patients who experienced ADRs to medicines including BL antibiotics. For multi-drug administration, a prescription survey hardly helped in confirming BL allergy. Anaphylaxis is common in patients with BL allergy, frequently leading to emergency room visits. Cefaclor and amoxicillin are common culprits. (Korean J Med 2021;96:42-47)