PurposeSkin allergies through type 1 and 4 hypersensitivity reactions are the most frequent manifestations of drug allergies. We had previously experienced a case of a nurse with cefotiam-induced contact urticaria syndrome. To aid in preventing the progression of drug-induced allergic disease in nurses, we conducted a survey of tertiary hospital nurses who were likely to have been exposed professionally to antibiotics.MethodsAll 539 staff nurses at a tertiary hospital were asked to respond to a questionnaire regarding antibiotic exposure. Of the 457 nurses (84.8%) who responded, 427 (79.2%) received a physical examination of the hands and 318 (59.0%) received skin prick tests with the β-lactam antibiotics cefotiam, cefoperazone, ceftizoxime, flomoxef, piperacillin and penicillin G.ResultsA positive response to at least one of the antibiotics occurred in 8 (2.6%) of the 311 subjects included in the analysis and stages 1 and 2 contact urticaria syndrome were observed in 38 (8.9%) and 3 (0.7%) of 427 nurses, respectively. The frequencies of a positive antibiotic skin test (6.9 versus 1.3%, χ2=7.15, P=0.018), stage 1 contact urticaria syndrome (14.4 versus 7.4%, χ2=4.33, P=0.038) and drug allergy (15.3 versus 3.6%, χ2=18.28, P=0.000) were higher in subjects with a positive skin allergy history than in those without. Allergic rhinitis (P=0.02, OR=3.86, CI=1.23-12.06), night cough (P=0.04, OR=3.12, CI=1.03-9.41) and food allergy (P=0.00, OR=9.90, CI=3.38-29.98) were significant risk factors for drug allergy.ConclusionsAntibiotic sensitization and drug allergy occurred more frequently in nurses with a positive skin allergy history. Atopy may be an important risk factor for drug allergy.

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A 29 years old female with chronic myelogenous leukemia underwent an unmanipulated, unrelated, HLAmatched peripheral blood stem cell transplantation (PBSCT) after imatinib mesylate treatment. The patient and donor had different ABO blood types and at 1 year later after PBSCT, the patient showed severe autoimmune hemolytic anemia (AIHA). She was treated with several immunosuppressive agents including high-dose steroid, cyclophosphamide, intravenous immunoglobulin and rituximab and underwent multiple sessions of plasma exchange. As her AIHA showed no response to these multiple therapies, she underwent splenic artery embolization and splenectomy. After then her AIHA was resolved with low dose oral steroid maintenance. Although the incidence of AIHA is known to be increased after allogeneic hematopoietic stem cell transplantation (HSCT), it has been rarely reported in Korea. Since AIHA in the setting of post-allogeneic HSCT is often difficult to treat and the prognosis is very poor, the accurate and early diagnosis is needed.