J Korean Med Sci.  2011 May;26(5):682-685. 10.3346/jkms.2011.26.5.682.

A Case of Piperacillin-induced Occupational Anaphylaxis: Detection of Serum IgE to Piperacillin-HSA Conjugate

• Kim JE
• Kim SH
• Kim JH
• Bahn JW
• Jin HJ
• Ye YM
• Park HS

• KMID: 1777870
• DOI: http://doi.org/10.3346/jkms.2011.26.5.682

Abstract

This is the first reported detection of serum IgE antibody to piperacillin-human serum albumin (HSA) conjugate in a patient presenting with anaphylaxis that developed after occupational exposure. A 24-yr-old nurse, who had worked at a University Hospital for 2 yr, experienced chest tightness, dizziness, generalized urticaria, abdominal pain, and diarrhea 10 min after administering a piperacillin injection. She had previously suffered from atopic dermatitis. A skin prick test for common inhalant allergens was entirely negative; in contrast, her serum total IgE was elevated (283 IU/mL). A high level of piperacillin-specific serum IgE was detected by ELISA using piperacillin-HSA conjugate. Significant inhibition upon addition of both free piperacillin and piperacillin-HSA conjugate was detected by inhibition ELISA. These data suggest that piperacillin exposure in the workplace can induce occupational anaphylaxis and urticaria mediated by an interaction of IgE with the hapten of piperacillin.

Keyword

Anaphylaxis; Piperacillin; Occupational Diseases; IgE

MeSH Terms

Anaphylaxis/*chemically induced/immunology
Enzyme-Linked Immunosorbent Assay
Female
Hospitals, University
Humans
Immunoglobulin E/*blood/immunology
Intensive Care Units
Occupational Diseases/*chemically induced/immunology
*Occupational Exposure
Piperacillin/*immunology
Serum Albumin/*immunology
Urticaria/immunology
Young Adult

Figure

• 

  Fig. 1 Measurement of piperacillin specific IgE antibodies by inhibition ELISA. Levels of specific IgE to piperacillin-human serum albumin (HSA) conjugate in patient serum (•), collected at the initial visit (A) and after 5 yr' avoidance (B) and in sera from unexposed, non-atopic healthy control subjects (◦). Horizontal bars indicate the cut-off values (mean plus three standard deviations of the absorbance values of controls).

• 

  Fig. 2 Effect of piperacillin-HSA conjugate (•), free piperacillin (◦), or HSA only (▴) in an inhibition ELISA. Both piperacillin-HSA conjugate and free piperacillin showed significant inhibition.

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