Asthma due to inhaled chemical agents: ampicillin, benzyl penicillin, 6 amino penicillanic acid and related substances

Abstract

Summary Three out of four workers from an antibiotic‐producing factory developed late asthma and eosinophilia on inhalation challenge testing with ampicillin and related substances. The chemicals to which each worker reacted varied, suggesting differences in the clinically important allergens for each individual. The taking by mouth of ampicillin in one patient, and benzyl penicillin in another in therapeutic doses led to the development of late asthma accompanied by skin and gastro‐intestinal disturbances. The inhalation of 200 μg of beclomethasone dipropionate before in one case, and before and 3‐hourly after provocation challenge in the other, blocked the late asthmatic reaction. 40 mg sodium cromoglycate similarly given failed to inhibit the reactions. In one patient, 04416–0.24 mg of isoprenaline sulphate inhaled 10 min before or 60 min after inhalation testing prevented the development of late asthma, and when given during the asthmatic reaction led to its rapid reversal.

Occupational asthma, rhinitis and urticaria due to piperacillin sodium in a pharmaceutical worker

“…In particular, the causal role of penicillin and its derivatives has been proved by means of specific bronchial challenges [5,6]. To our knowledge, this is the first case described of occupational asthma caused by piperacillin sodium.…”

“…Among low molecular weight chemicals, antibiotics are well-known as agents able to induce occupational asthma in exposed workers [5][6][7][8][9][10][11][12]. In particular, the causal role of penicillin and its derivatives has been proved by means of specific bronchial challenges [5,6].…”

Health hazard evaluation report: GHE-80-169-1300, Mylan Pharmaceuticals, Morgantown, West Virginia.

“…These can reoccur in a gradually decreasing manner for several consecutive nights after a single exposure. (4,10,11) In summary, the study was unable to establish definitive patterns of occupational asthma resulting from penicillin exposure at Mylan Pharmaceuticals . However, .there Jlppears to be excessive prevalence of asthma-like respiratory sy~ptoms in penicillin-exposed workers.…”

“…Shift spirometry should be oerformed on a day when the examined worker is doing the job of the highest dust exposure, and is not using any lung medication. 4. Individuals with decrement in FEV1 of 10% or more during the shift, should be transferred to a nonpenicillin exposure work assignment.…”

Jack Pepys' contributions to the medical literature

“…17 Most often, the suspected agent was mixed in increasing amounts with lactose, which the patient poured back and forth from one tray to another (Figs 1 and 2). This approach was used for piperazine hydrochloride 18 ; wood dusts 19 ; complex salts of platinum 20 ; products of antibiotic manufacturing such as ampicillin, benzyl penicillin, 6-amino penicillin acid and related substances, 21 spiramycin, 22 tetracycline, 23 and intermediate products of sulbutamol 24 ; wheat flour for baker's asthma 25 ; and insect products such as carmine 26 and locusts from a breeding facility. 27 When the occupational exposure resulted from fumes, these were generated for the challenges, as with aminoethyl ethanolamine in aluminum soldering, 28 colophony (pine resin) soldering flux, 29 and electronic soldering 30 ; epoxy resins containing phthalic acid anhydride, trimellitic acid anhydride, and triethylene tetramine 31 ; toluene diisocyanate as a component of varnishes 32 ; and fumes from persulfate salts and henna used in hairdressing.…”