piperacillin--tazobactam-drug-combination and Anaphylaxis

Piperacillin is a beta-lactam antibiotic of penicillin family. Some penicillins were report-ed as occupational diseases cause, but piperacillin anaphylaxis with occupational sensi-tization is rare. We describe the case of a female nurse with recurrent anaphylaxis in last few months without apparent cause, only in work environment. Latex allergy was excluded after negative latex glove provocation. Later during diagnostic workup, the patient reported a similar reaction minutes after piperacillin preparation. She denied any previous antibiotic therapeutic exposure. Skin prick tests (SPT) to beta-lactams were positive to piperacillin, penicillin G and major and minor determinants. SPT to cefuroxime was negative but intradermic test was positive. The patient has indication for beta-lactams eviction and for adrenaline auto-injector kit. No further reactions occurred after patient's transfer to another department with minimum possible exposure. Allergic risk prevention is essential and must be rapidly implemented to avoid incapacitating occupational diseases development.

Topics: Adult; Anaphylaxis; Drug Hypersensitivity; Female; Humans; Hydrocortisone; Nurses; Occupational Diseases; Piperacillin, Tazobactam Drug Combination; Skin Tests

Skin prick testing (SPT) has been regarded as a safe procedure with few systemic reactions.. To evaluate the rate of systemic reactions and their associations after SPT in the largest population to date.. In this study reactions were recorded prospectively in a specialist UK allergy clinic for 6 years (2007-2013). An estimated 31,000 patients underwent SPT.. Twenty-four patients (age range 7 months to 56 years, mean 23.5 years, 17 female patients, 12 with asthma) had systemic reactions. The rate of systemic reactions to SPT was 0.077%. The likely allergens causing the reaction were foods (18; peanut, 7; walnut, 1; Brazil nut, 2; pistachio, 1; lupin, 1; cow's milk, 2; shrimp, 1; spinach, 1; legume, 1; soy, 1), aeroallergens (4; rabbit, 1; rat, 1; ragwort, 1; grass pollen, 1), wasp venom (1), and Tazocin (1). The causative SPT wheal was larger than 8 mm in 75%. The reaction to Tazocin was severe, with anaphylaxis occurring minutes after SPT. Reactions were treated immediately in the clinic and did not require further medical care.. In this largest single-center study, the rate of systemic reactions after SPT was 77 per 100,000 patients. It is the first study to identify foods as a common and important cause (75%), with nuts posing the highest risk. This study reports the first systemic reaction to venom SPT and the first anaphylactic reaction after drug SPT. There was an association with a history of severe reactions and large skin test reaction. There are risks, albeit small, when undertaking SPT.

Topics: Adolescent; Adult; Allergens; Anaphylaxis; Child; Child, Preschool; Erythema; Female; Food Hypersensitivity; Humans; Infant; Male; Middle Aged; Nut Hypersensitivity; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prospective Studies; Retrospective Studies; Skin Tests; Urticaria; Young Adult

Topics: Adult; Anaphylaxis; Anti-Allergic Agents; Anti-Bacterial Agents; Anti-Inflammatory Agents; Blood Pressure; Bronchodilator Agents; Crohn Disease; Dexamethasone; Diphenhydramine; Epinephrine; Female; Heart Rate; Humans; Intestinal Fistula; Penicillanic Acid; Penicillins; Piperacillin; Piperacillin, Tazobactam Drug Combination; Predictive Value of Tests; Radioallergosorbent Test; Skin Tests