rifamycin-sv and Anaphylaxis

Topics: Administration, Oral; Administration, Topical; Anaphylaxis; Cross Reactions; Drug Hypersensitivity; Humans; Immunoglobulin E; Male; Middle Aged; Rifamycins; Rifaximin; Surgical Wound Infection

A patient developed severe anaphylaxis during irrigation of a wound with rifamycin SV. The temporal relationship between application of rifamycin SV, the positive skin test and basophil activation test for rifamycin SV strongly supported diagnosis of anaphylaxis from the locally applied antibiotic. However, after operation the patient had two anaphylactic reactions with pruritus, urticaria and angio-oedema after routine care by a nurse, and these were probably caused by natural rubber latex. This case report has several messages. First, it is not widely appreciated that topically applied drugs and related compounds can elicit life-threatening anaphylaxis. Second, it illustrates patients can present with more than one allergy. Finally, it provides an opportunity to summarize the applications of flow cytometry-assisted quantification of in vitro activated basophils in diagnosing the cause of anaphylaxis during anaesthesia.

Topics: Administration, Topical; Adult; Anaphylaxis; Anti-Bacterial Agents; Drug Hypersensitivity; Humans; Intraoperative Complications; Latex Hypersensitivity; Male; Postoperative Complications; Rifamycins

Topics: Anaphylaxis; Anti-Bacterial Agents; Anti-Infective Agents; Antirheumatic Agents; Ciprofloxacin; Drug Hypersensitivity; Humans; Male; Middle Aged; Rifamycins

Topics: Anaphylaxis; Anesthetics; Anti-Bacterial Agents; Antibodies, Anti-Idiotypic; Antibody Specificity; Antirheumatic Agents; Female; Humans; Middle Aged; Rifamycins

Anaphylaxis to topical application of rifamycin SV, which is used topically in the fields of surgery and dermatology, is rare.. We report two cases of systemic reactions occurring after local administration of rifamycin (Rifocine, Gruppo Lepetit, Italy). Both of them needed repeated intermittent topical applications. Skin prick tests with Rifocine constituents were performed on our patients, and also on ten atopic and ten nonatopic subjects. Although an old investigative tool, Prausnitz-Küstner (P-K) test was also performed on one of the patient's spouses to show passive transfer and the IgE-mediated mechanism.. Allergy assessment with skin tests on the patients were negative for aeroallergens, latex, and Rifocine constituents (except rifamycin SV). The patients' prick tests with rifamycin SV were positive, and the control subjects were negative. P-K testing was positive.. Two case reports support the existence of IgE-mediated reactions to rifamycin SV. IgE-mediated anaphylactic reactions from rifamycin SV appear to be extremely rare.

Topics: Administration, Topical; Anaphylaxis; Antirheumatic Agents; Drug Hypersensitivity; Female; Humans; Intradermal Tests; Middle Aged; Rifamycins; Skin Tests; Surgical Wound Infection

Systemic reactions during anesthesia are commonly attributed to muscle relaxants, hypnotics, macromolecular solutions, latex, or parenteral antibiotics. After exclusion of these different components as causes, we were interested in the potential implication of rifamycin in the systemic reaction, which occurred during anesthesia, and in the immunologic mechanism by which it can trigger this reaction.. We report four cases of systemic reactions occurring after local administration of rifamycin. Three patients needed orthopedic surgery, and the fourth needed a urethrotomy. Severe systemic reactions occurred in all four patients when the surgeon washed the incision area with a rifamycin solution. All patients correctly responded to appropriate treatment and recovered. Skin tests were performed 2 months after the incident with the drugs used during anesthesia, latex, and rifamycin. To assess the relationship with a possible IgE-mediated mechanism, two in vitro tests were concomitantly performed to evaluate the cell reactivity to rifamycin: (1) determination of histamine release from peripheral basophils and (2) platelet cytotoxicity test, which explored the presence on platelets of specific IgE antibodies bound to the low-affinity receptor for IgE.. Skin tests were performed with different drugs used during surgery, and results were only positive for rifamycin in the four cases, accompanied in two cases by a systemic reaction. Histamine release from basophils was positive in three of four patients. The platelet cytotoxicity test results were positive in all four cases.. It appears that rifamycin, used locally during surgery, is apt to trigger severe systemic anaphylactic reactions, which are linked to an IgE-related process. This situation is worth pointing out, especially in patients who undergo repeated orthopedic operations during which, at least in Europe, rifamycin is commonly used for the prevention of local sepsis.

Topics: Administration, Topical; Adult; Aged; Anaphylaxis; Blood Platelets; Cytotoxicity Tests, Immunologic; Histamine Release; Humans; Immunoglobulin E; Intraoperative Complications; Male; Middle Aged; Orthopedics; Rifamycins; Skin Tests

Topics: Anaphylaxis; Dermatitis, Contact; Drug Eruptions; Humans; Male; Middle Aged; Rifamycins; Urticaria