Specific IgE sensitization to cephalosporins in hospital personnel

Background: Cephalosporins can induce occupational allergies including asthma, urticaria, and anaphylaxis. This study evaluates the sensitization rate and the risk factors for sensitization to cephalosporins in hospital personnel.

Method: A total of 167 hospital personnel, including 128 nurses working at wards (currently being exposed group), 14 nurses working at outpatient clinics or at offices (not currently but previously exposed group), and 25 pharmacists (unexposed group) were enrolled.  We also enrolled 86 unexposed non-atopic healthy controls.  The questionnaire contained items including the work place, intensity of exposure, duration of employment, cephalosporin associated work related symptoms (WRS), and past history of allergic diseases including bronchial asthma, allergic rhinitis, atopic dermatitis, chronic urticaria, and experiences of internal or parenteral antibiotic use and antibiotic allergy after those.  Skin prick tests (SPTs) to commonly used intravenous cephalosporins including cefotiam, ceftriaxone, and ceftizoxime and SPT to common inhalant allergens were performed.  Serum specific IgE antibodies to each cephalosporin-HSA conjugate were measured by ELISA.  Total IgE level was measured by immunoCAP system. The binding specificities were confirmed by ELISA inhibition tests.

Results: The prevalence of cephalosporin associated WRS was 17.0%.  Ceftriaxone was the only cephalosporin which responded to SPT and the sensitization rate using SPT to ceftriaxone was 3.1%. The sensitization rate using serum specific IgE antibody to any cephalosporin-HSA conjugate was 17.0%, where the sensitization rate was the highest to cefotiam (9.1%) followed by ceftriaxone (6.7%) and ceftizoxime (3.6%).  The past history of antibiotic allergy was a risk factor for cephalosporin associated WRS (OR, 24.9; 95% CI, 2.6-238). On the other hand, the past history of atopic dermatitis was a risk factor for high serum specific IgE antibody (OR, 6.5; 95% CI, 1.2-34.6) to cefotiam-HSA conjugate.

Conclusion: Cephalosporins can be sensitized through the skin contact as well as inhalation in hospital personnel. Atopic dermatitis would be a risk factor for sensitization to cefotiam. Monitoring of serum specific IgE to cephalosporin-HSA conjugate would be more useful to detect the sensitized subjects than SPT.