rifamycin-sv and Drug-Hypersensitivity

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

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

Topics: Animals; Dogs; Drug Hypersensitivity; Guinea Pigs; Lagomorpha; Mice; Rabbits; Research; Rifamycins; Toxicology