IgE Sensitization to Cephalosporins in Health Care Workers

Abstract

PurposeCephalosporins can induce occupational allergies, such as asthma, urticaria, and anaphylaxis. We investigated the prevalence and risk factors of sensitization to cephalosporin.MethodsA total of 161 health care workers (HCW), including 138 nurses and 23 pharmacists, and 86 unexposed non-atopic healthy controls were recruited from a single tertiary hospital and the general population. A questionnaire regarding work-related symptoms was administered along with skin prick tests (SPT) to the three most commonly used cephalosporins (cefotiam, ceftriaxone, and ceftizoxime). Serum specific IgE antibodies to conjugates of the three cephalosporins and human serum albumin (HSA) were measured by enzyme-linked immunosorbent assay (ELISA). Binding specificities were confirmed by ELISA inhibition tests.ResultsThe prevalence of work-related symptoms in association with cephalosporins was 17.4%. The sensitization rate to any cephalosporin was 3.1% by SPT. Sensitization rates determined by measurement of serum specific IgE antibodies were 17.4% for any cephalosporin, 10.4% for cefotiam, 6.8% for ceftriaxone, and 3.7% for ceftizoxime. A personal history of any antibiotic allergy was a risk factor for work-related symptoms (OR, 24.93; 95% CI, 2.61-238), but not for the presence of serum specific IgE antibodies to cephalosporins (OR, 0.9; 95% CI, 0.18-4.53). A personal history of atopic dermatitis was a risk factor for the presence of serum specific IgE antibodies to cefotiam-HSA conjugate (OR, 6.30; 95% CI, 1.23-32.3).ConclusionsA high cephalosporin sensitization rate (17.4%) was detected by ELISA in HCW exposed to cephalosporins. Monitoring of serum specific IgEs to cephalosporin-HSA conjugates will be useful for detecting sensitized subjects.

Occupational generalized urticaria and anaphylaxis after inhalation of cefuroxime in a nurse

“…However, neither of these studies included a control group, making the test procedures difficult to interpret. Only one study from Korea included a control group of healthy volunteers . That study reported a sensitization rate to any cephalosporin of 3.1% (skin prick test) and 17.4% (ELISA), but anaphylaxis had occurred in only one (0.8%) of 161 health care workers.…”

Occupational anaphylaxis - an EAACI task force consensus statement

“…An earlier study reported sensitization rates of 12% to penicillin in nonallergic nurses . This effect is also seen with cephalosporins with 17.4% of 161 Korean HCW having specific IgE to cefotiam, ceftriaxone, or ceftizoxime . The risk was higher in those with atopic dermatitis.…”

Immunologic Evaluation of Ofloxacin Hypersensitivity

“…Atopy was defined as a positive SPT for at least one common aeroallergens (Bencard Co., Bredford, UK). To detect serum specific IgE and IgG antibodies, ofloxacin-HSA conjugate was prepared in our laboratory and ELISA was performed as described previously 2,3. In brief, microplates (Corning, New York, NY, USA) were coated with the ofloxacin-HSA conjugate (10 µg/mL) and were incubated with sera of patients or controls.…”