Anaphylaxis induced by prick test wiyh sodium amoxicillin probably due to specific recognition of lateral chain 1 of the betalactam ring: a case report

Abstract

Event Abstract Back to Event Anaphylaxis induced by prick test wiyh sodium amoxicillin probably due to specific recognition of lateral chain 1 of the betalactam ring: a case report Carlos D. Serrano1*, Luis F. Ramirez1 and Manuela Olaya1 1 Fundación Valle del Lili, Colombia Introduction Liophylized sodium amoxicillin is the choice extract to the study of allergic reactions to this drug. The likelihood of hypersensitivity reactions during allergy study is very low; in fact, only one case has been reported in the past 10 years (1). Our aim is to report the case of a female patient with an exceeding hypersensitivity to betalactam antibiotics sharing the same lateral chain 1 of the betalactam ring. Case description and aproach (Methods) A 63 years old female was seen in our clinic. She had a history of cephalexin-induced anaphylactic shock several years ago. Six months before the visit, she tested an amoxicillin-contain syrup with the tip of the tongue and after few seconds, developed a severe anaphylactic reaction associated to unconsciousness. In relation to this situation is treated in our unit. Allergy study was conducted six months later. Single-blind prick test with placebo (normal saline) was first performed by marked anxiety of the patient. Later, prick test with PPL, MDM and sodium amoxicillin (Diater Laboratories, Madrid) were carried out. Results Few minutes after the prick test with amoxicillin was done, the patient developed a local reaction of 21 x 16 mm with extensive erythema, palmar and plantar itching, respiratory distress, severe dizziness and sensation of imminent loss of consciousness. Her BP was 100/60, her pulse 100 X', and her O2 saturation of 96%. We applied epinephrine 0.3 mg intramuscularly in the right thigh and six minutes later, 0.5 mg in the left thigh by non-response. Also, we did to her three puff of albuterol (300 mcg). IV access was obtained, 1000 cc of normal saline were infused and 100 mg of hydrocortisone administered. Few minutes later, the patient fully recovered, rising her BP to 120/80. Short course of prednisone and antihistamines were given to prevent delayed reactions. The prick test with PPL and MDM were negative. We could not perform intradermal tests by the clinical picture of the patient. Conclusion Medical history (anaphylaxis to cephalothin and amoxicillin) and negativity of prick tests to PPL and MDM suggests a selective side chain 1 allergy, which is shared by both antibiotics. Additional studies (probably including an oral challenge with penicillin V) are needed to categorically state this hypothesis References Syrigou E, Syrigos K. Anaphylaxis during skin prick testing for amoxicillin allergy. J Allergy Clin Immunol Pract. 2014; 2(4): 478-9. Keywords: Hypersensitivity, severe anaphylaxis, sodium amoxicillin, Cephalexin, skin prick test Conference: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología, Medellin, Colombia, 13 Oct - 16 Oct, 2015. Presentation Type: Oral Presentation Topic: Allergy Citation: Serrano CD, Ramirez LF and Olaya M (2015). Anaphylaxis induced by prick test wiyh sodium amoxicillin probably due to specific recognition of lateral chain 1 of the betalactam ring: a case report. Front. Immunol. Conference Abstract: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología. doi: 10.3389/conf.fimmu.2015.05.00292 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 Jun 2015; Published Online: 15 Sep 2015. * Correspondence: Dr. Carlos D Serrano, Fundación Valle del Lili, Cali, Colombia, cdserranoreyes@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Carlos D Serrano Luis F Ramirez Manuela Olaya Google Carlos D Serrano Luis F Ramirez Manuela Olaya Google Scholar Carlos D Serrano Luis F Ramirez Manuela Olaya PubMed Carlos D Serrano Luis F Ramirez Manuela Olaya Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.