Allergie aux antibiotiques dans la mucoviscidose : cohorte rétrospective des patients adultes suivis au centre de ressources et de compétences pour la mucoviscidose d’Angers et revue de la littérature

Abstract

Cystic fibrosis is a hereditary disease of which the prognosis is related to respiratory and infectious complications. Allergic hypersensitivity reactions to antibiotics, particularly β-lactams, appear to affect between 6 and 30% of patients. Our objective was to describe (frequency, nature, chronology) suspected antibiotic hypersensitivity reactions in adults followed up at the resource and competence centre for cystic fibrosis in Angers and sent to allergology consultations and to evaluate the results of the allergology assessment (skin and drug challenge tests) and drug desensitization. Twelve of the 64 patients followed up in Angers between 2004 and 2017 were referred in allergology: 5 patients for suspected allergy to 1 antibiotic and 7 patients for suspected allergy to several antibiotics. Twenty-three reactions were reported, 9 of which were immediate, 12 non-immediate and 2 of indeterminate chronology. The most common symptoms were maculopapular exanthema and angioedema; there was no severe reaction. Antibiotic hypersensitivity was diagnosed in 8 patients based on positive responses in skin tests and challenge tests in 60 and 20% of patients respectively, and on strong accountability of drug causality and case history despite negative skin tests for 2 patients with fixed drug eruption. The most commonly incriminated antibiotic (suspected and proven) was ceftazidime followed by trimethoprim–sulfamethoxazole and piperacillin–tazobactam. Four desensitisations were performed with good safety in 3 cases. Thus, the prevalence of proven antibiotic hypersensitivity was 12.5% in our population. Our results confirm that a complete allergological assessment is essential to confirm or exclude the allergic nature of the reaction, resulting proposal of either a therapeutic alternative or drug desensitization.