Clinical and genetic risk factors of self-reported penicillin allergy

Apter, Andrea J.; Schelleman, Hedi; Walker, A. D.; Addya, Kathakali; Rebbeck, Timothy R.

doi:10.1016/j.jaci.2008.03.037

Cited by 69 publications

(46 citation statements)

References 31 publications

(40 reference statements)

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“…Based on our results that allergic rhinitis and food allergy were important risk factors for drug allergies, as was also shown in a recent study,32 even though drug allergy has been known not to be prevalent in atopic subjects, atopy may play a crucial role in the development of drug allergy.…”

Section: Discussionsupporting

confidence: 85%

“…The present study found that atopy was significantly related to drug allergy. Recently, Apter et al32 have also demonstrated that atopy, as well as interleukin-4 polymorphism, significantly correlates with drug allergy in patients with a self-reported penicillin allergy. A penicillin allergy can be induced by various types of allergic reactions in addition to an IgE-mediated reaction and therefore the statistical significance of the relationship between atopy and drug allergy in a given study may depend on the proportion of study subjects with an IgE-mediated allergic reaction.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Choi

Han

Lim

et al. 2010

Allergy Asthma Immunol Res

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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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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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

Choi

Han

Lim

et al. 2010

Allergy Asthma Immunol Res

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“…In the late 1960s, atopy was reported for the first time as a risk factor for penicillin allergy [23]. More recently, authors from southern Spain and the USA observed that atopy was related to β-lactam allergy in their patients [44, 45]. In France, another study group reported that atopy is a personal risk factor for NSAID hypersensitivity [46].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients

Demir¹,

Erdenen²,

Gelincik

et al. 2018

Int Arch Allergy Immunol

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Aim: To investigate the potential risk factors in patients who have experienced anaphylaxis from drugs. Method: The study included 281 adult patients (median age 40 years; 76.5% female) who experienced immediate types of hypersensitivity reaction to a drug. The patients were divided into an anaphylaxis group and a nonanaphylaxis group. The anaphylaxis group was diagnosed according to the criteria of the World Allergy Organization. Skin testing with culprit drugs was performed. In the nonanaphylaxis group, drug provocation tests were performed with culprit drugs, including aspirin or diclofenac, to determine nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. Atopy was determined by skin prick tests with the common inhalant allergens. Patients’ demographics, clinical features, and baseline tryptase and total IgE levels were compared between the 2 groups. Results: The median interval between the last reaction in the patient’s history and the study evaluation was 7 months (range 1–120 months). In 52.3% of the patients, reactions were defined as anaphylaxis. The most common culprit drugs were NSAIDs (56.9%) and β-lactams (34.7%). The culprit drugs were used parenterally in 13.2% of the patients. 34.9% of the patients had comorbid diseases and 24.6% used additional drugs, the most common being antihypertensives (10%). Atopy was determined in 28.8% and 28.1% of the patients were smokers. The median serum level of baseline tryptase and total IgE was 3.5 µg/L and 77 kU/L, respectively. In 46.3% of the patients, skin tests with culprit drugs were positive and the positivity ratio was higher in the anaphylaxis group (p = 0.002). Anapyhlaxis was more common in patients who were: hypertensive, atopic, using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and received the culprit drug parenterally (p = 0.034, p = 0.04, p = 0.03, p = 0.035, p = 0.013, and p < 0.001). In the multivariate analysis, it was observed that the parenteral usage of the drug and the presence of atopy were significantly higher in the anaphylaxis group (p < 0.001, odds ratio [OR] = 20.05, confidence interval [CI] 4.75–88.64; p = 0.012, OR = 2.1, CI 1.17–3.74). Age, smoking, family history, and serum levels of baseline tryptase and total IgE did not differ between groups. Conclusion: The parenteral route and atopy increase the risk of drug-induced anaphylaxis. IgE-mediated sensitivity to the culprit drug seems to facilitate anaphylaxis.

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“…With regard to the IL-4 gene, the T allele of IL-4-589T > C, known as the promoter region of IL-4, is related to asthma and elevated serum total IgE (11). The IL-4-33C > T polymorphism was shown to be significantly associated with penicillin allergy in an American population (12) and associated with asthma, serum IL-4, and total IgE levels in a Russian population (33). …”

Section: Discussionmentioning

confidence: 99%

“…Interleukin-4 (IL-4) is a major cytokine in IgE production and is involved in IgE-mediated responses. IL-4-589T > C (11) and IL-4-33C > T (12) have been shown to be associated with increased serum total IgE levels as well as the development of asthma and drug allergy. Given this background, we hypothesized that four single-nucleotide polymorphisms (SNPs) may be associated with occupational allergy due to cephalosporins in exposed HCWs: FcεR1β -109T > C, FcεR1β -237A > G, IL-4-589T > C, and IL-4-33C > T.…”

Section: Introductionmentioning

confidence: 99%

Identifying Genetic Susceptibility to Sensitization to Cephalosporins in Health Care Workers

Nam

Kim

et al. 2012

J Korean Med Sci

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Exposure to cephalosporins could cause occupational allergic diseases in health care workers (HCWs). We evaluated the prevalence of serum specific IgE and IgG antibodies to cephalosporin-human serum albumin (HSA) conjugate and to identify potential genetic risk factors associated with sensitization to cephalosporins in exposed HCWs. The study population consisted of 153 HCWs who had been exposed to antibiotics in a single university hospital and 86 unexposed healthy controls. A questionnaire survey of work-related symptoms (WRS) was administered. A skin-prick test (SPT) was performed, and serum-specific IgE and IgG antibodies to 3 commonly prescribed cephalosporins were measured by ELISA. Four single-nucleotide polymorphisms of the candidate genes related to IgE sensitization were genotyped. The prevalence of WRS to cephalosporins was 2.6%. The prevalence rates of serum-specific IgE and IgG antibodies to cephalosporins were 20.3% and 14.7%, respectively. The FcεR1β-109T > C polymorphism was significantly associated with IgE sensitization to cephalosporins in HCWs (P = 0.036, OR = 3.553; CI, 1.324-9.532). The in vitro functional assay demonstrated that the T allele of FcεR1β-109T had greater promoter activity than did the C allele (P < 0.001). The FcεR1β-109T > C polymorphism may be a potential genetic risk factor for increased IgE sensitization to cephalosporins.

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Clinical and genetic risk factors of self-reported penicillin allergy

Cited by 69 publications

References 31 publications

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

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

Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients

Identifying Genetic Susceptibility to Sensitization to Cephalosporins in Health Care Workers

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