Beta-Lactam Antibiotic Sensitization and Its Relationship to Allergic Diseases in Tertiary Hospital Nurses

Abstract

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.

IgE Sensitization to Cephalosporins in Health Care Workers

“…A beta-lactam antibiotic sensitization rate of 2.6% as measured by SPT was reported in nurses working in a tertiary hospital 12. One study reported that the sensitization rate by SPT and intradermal (ID) tests to benzylpenicilloyl polylysine (PPL) and a mixture of minor antigenic determinants (MDM) was 12% in 83 asymptomatic Turkish nurses 13.…”

Update in drug allergy: novel drugs with novel reaction patterns

“…It was also found that atopy may be a risk factor for developing sensitization to betalactam antibiotics in tertiary hospital nurses [15].…”

How should occupational anaphylaxis be investigated and managed?

“…Although anaphylaxis is less frequent, there is often a history of milder self-limiting reactions prior to its development. Anaphylaxis can take place in the workplace; however, it may also happen when the sensitized worker receives the implicated medication as a patient [23].…”