Allergie à l’amoxicilline : anciens concepts, nouveaux concepts et changement de concepts
Résumé
Plus qu’un million d’enfants canadiens sont traités annuellement par des antibiotiques, principalement l’amoxicilline.Jusqu’à 10 % des enfants développent des éruptions cutanées lors du traitement par amoxicilline. La majorité des enfants présentant des éruptions cutanées durant la prise d’amoxicilline ont reçu un diagnostic d’hypersensibilité à l’amoxicilline sans autre évaluation et continuent de le recevoir à l’âge adulte. Il persiste une controverse dans la littérature médicale quant à la stratégie la plus précise et la plus sûre à adopter pour le diagnostic de l’hypersensibilité à l’amoxicilline. En conséquence, la plupart des enfants prennent tout au long de leur vie d’autres médicaments jugés moins efficaces, plus toxiques et plus coûteux que l’amoxicilline et d’autres dérivés de la pénicilline. Nous ignorons encore beaucoup de choses au sujet de la pathogenèse de l’hypersensibilité à l’amoxicilline. La stratégie diagnostique appropriée requise pour établir la présence d’une vraie hypersensibilité à l’amoxicilline est donc incertaine. Afin de développer une approche diagnostique adéquate, il est important de comprendre les mécanismes pathogènes expliquant l’hypersensibilité à l’amoxicilline et la validité des tests de confirmation disponibles. Le présent article porte sur les mécanismes pathogènes sous-jacents de l’allergie à l’amoxicilline. Il décrit les difficultés de diagnostic de l’allergie à l’amoxicilline, mène une évaluation critique du rôle du test cutané et des taux d’IgE et se penche sur la stratégie diagnostique appropriée à adopter chez les personnes présentant une suspicion d’allergie à l’amoxicilline.
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