Occupational Contact Anaphylaxis from Piperacillin in a Nurse with Atopic Dermatitis

Abstract

Background: Piperacillin is a highly effective bactericidal ureidopenicillin with a broad spectrum of activity. There have been very few reports of anaphylaxis induced by intravenous piperacillin injection, and to the best of our knowledge, there were no reported cases of anaphylaxis by contact with piperacillin.Case Report: This report describes a nurse who experienced anaphylaxis after skin contact with piperacillin solution. A 24-year-old nurse who are working in our hospital rapidly developed urticaria, respiratory distress, dizziness, vomiting and diarrhea, and hypotension with systolic pressure of 80 mmHg after skin contact with piperacillin/tazobactam solution. After emergency treatment with intramuscular epinephrine, methyl-prednisolone, and chlorpheniramine intravenously, her symptoms resolved completely in 6 h. She had been working on medical intensive care unit for 2 years in our hospital. She had had atopic dermatitis since her childhood, and had suffered frequent aggravation of skin symptoms during work, especially after handling of piperacillin/tazobactam. On skin prick test with 55 common inhalant allergen, all the responses were negative. Prick and intradermal test with piperacillin, penicillin G, amoxicillin, cefazolin, cefuroxime, and cefotaxime. Prick test with piperacillin at 0.002 mg/ml produced a maximum wheal diameter of 8 mm. Intradermal penicillin and ampicillin produced equivocal response at high concentration. Prick and intradermal test with above cephalosporins were negative. These findings suggest that she may have developed IgE-mediated hypersensitivity reaction selective to piperacillin.Thereafter, she was relocated to other ward where antibiotics are rarely handled.CONCLUSIONS: Contact with piperacillin in hospital personnel may cause anaphylaxis, and the pathogenic mechanism is appeared to be IgE-mediated. Background: Piperacillin is a highly effective bactericidal ureidopenicillin with a broad spectrum of activity. There have been very few reports of anaphylaxis induced by intravenous piperacillin injection, and to the best of our knowledge, there were no reported cases of anaphylaxis by contact with piperacillin. Case Report: This report describes a nurse who experienced anaphylaxis after skin contact with piperacillin solution. A 24-year-old nurse who are working in our hospital rapidly developed urticaria, respiratory distress, dizziness, vomiting and diarrhea, and hypotension with systolic pressure of 80 mmHg after skin contact with piperacillin/tazobactam solution. After emergency treatment with intramuscular epinephrine, methyl-prednisolone, and chlorpheniramine intravenously, her symptoms resolved completely in 6 h. She had been working on medical intensive care unit for 2 years in our hospital. She had had atopic dermatitis since her childhood, and had suffered frequent aggravation of skin symptoms during work, especially after handling of piperacillin/tazobactam. On skin prick test with 55 common inhalant allergen, all the responses were negative. Prick and intradermal test with piperacillin, penicillin G, amoxicillin, cefazolin, cefuroxime, and cefotaxime. Prick test with piperacillin at 0.002 mg/ml produced a maximum wheal diameter of 8 mm. Intradermal penicillin and ampicillin produced equivocal response at high concentration. Prick and intradermal test with above cephalosporins were negative. These findings suggest that she may have developed IgE-mediated hypersensitivity reaction selective to piperacillin.Thereafter, she was relocated to other ward where antibiotics are rarely handled. CONCLUSIONS: Contact with piperacillin in hospital personnel may cause anaphylaxis, and the pathogenic mechanism is appeared to be IgE-mediated.