CEFOTIAM-INDUCED IGE-MEDIATED OCCUPATIONAL CONTACT ANAPHYLAXIS OF NURSES - CASE-REPORTS, RAST ANALYSIS, AND A REVIEW OF THE LITERATURE

Cefotiam (CTM) is one of the most popular cephem antibiotics in Japan. Recently we experienced two cases of nurses with CTM-induced contact anaphylaxis. When they were preparing drip infusions of antibiotics or working around other nurses doing so, they suddenly fell into shock w ith other symptoms such as flushing, urticaria, abdominal distress, vo miting, dyspnoea and/or loss of consciousness. The symptoms never occu rred after they avoided exposure to CTM. Passive cutaneous or open pat ch tests were positive for CTM. Histamine release was induced by CTM f rom washed leucocytes. RAST analysis using CTM-human serum albumin-cou pled discs showed high % RAST count, suggesting that these reactions w ere mediated by IgE antibodies. A PAST inhibition test suggested that the methyl-thiotetrazol side-chain was the main antigenic determinant. Both patients had hand dermatitis that had appeared preceding the epi sodes of anaphylaxis. Although the dermatitis had been resistant to tr eatments, it also disappeared after they avoided exposure to CTM. It s eemed likely that it was also induced or exacerbated by CTM and facili tated the penetration of CTM to cause anaphylaxis. The literature is a lso reviewed.