OCCUPATIONAL ASTHMA, RHINITIS AND URTICARIA DUE TO PIPERACILLIN SODIUM IN A PHARMACEUTICAL WORKER

A 28 year old man with no history of atopy was referred to our hospita l for possible work-related asthma. He had been employed in the produc tion section of a pharmaceutical company for 2 yrs, and in the last 2 months he had complained of dyspnoea, wheezing, chest tightness, sympt oms of rhinitis and a cutaneous rash when exposed to powdered antibiot ics. Symptoms disappeared after being transferred to the packaging sec tion. When the subject was admitted to our department he was asymptoma tic. Basal lung function tests were in the normal range. Bronchial cha llenges with methacholine and with ultrasonically-nebulized distilled water were negative. Skin-prick test with piperacillin sodium gave a s trong positive response at a very low concentration. Specific inhalati on challenge with piperacillin sodium resulted in an immediate asthmat ic reaction, and also reproduced rhinitis symptoms and the cutaneous r ash. A control challenge with lactose, and the specific challenge test with cefuroxime sodium (another antibiotic to which the patient was e xposed at the workplace) were negative. We conclude that piperacillin sodium is an agent that can cause occupational asthma.