Allergy Asthma Immunol Res.  2010 Apr;2(2):114-122. 10.4168/aair.2010.2.2.114.

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

• Choi IS
• Han ER
• Lim SW
• Lim SR
• Kim JN
• Park SY
• Chae SK
• Lim HH
• Seol YA
• Bae YI
• Won YH

• KMID: 2260597
• DOI: http://doi.org/10.4168/aair.2010.2.2.114

Abstract

PURPOSE
Skin 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.
METHODS
All 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 beta-lactam antibiotics cefotiam, cefoperazone, ceftizoxime, flomoxef, piperacillin and penicillin G.
RESULTS
A 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%, chi-square=7.15, P=0.018), stage 1 contact urticaria syndrome (14.4 versus 7.4%, chi-square=4.33, P=0.038) and drug allergy (15.3 versus 3.6%, chi-square=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.
CONCLUSIONS
Antibiotic 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.

Keyword

Drug hypersensitivity; beta-lactam antibiotics; contact urticaria syndrome; nurses

MeSH Terms

Anti-Bacterial Agents
Cefoperazone
Cefotiam
Ceftizoxime
Cephalosporins
Cough
Drug Hypersensitivity
Food Hypersensitivity
Hand
Hypersensitivity
Penicillin G
Physical Examination
Piperacillin
Rhinitis
Rhinitis, Allergic, Perennial
Risk Factors
Skin
Skin Tests
Tertiary Care Centers
Urticaria
Surveys and Questionnaires
Anti-Bacterial Agents
Cefoperazone
Cefotiam
Ceftizoxime
Cephalosporins
Penicillin G
Piperacillin

Figure

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  Fig. 1 The duration of dermal contact with antibiotics, duration of any allergic diseases and eosinophil counts in peripheral blood in nurses with and without a positive history of skin allergy in a tertiary hospital.

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  Fig. 2 The proportion of subjects who had a positive history of drug allergy, the contact urticaria syndrome and a positive skin prick test response to β-lactam antibiotics in nurses with and without a positive history of skin allergy in a tertiary hospital.

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