IgE Sensitization to Cephalosporins in Health Care Workers

Abstract

Purpose: Cephalosporins can induce occupational allergies, such as asthma, urticaria, and anaphylaxis. We investigated the prevalence and risk factors of sensitization to cephalosporin.

Methods: A total of 161 health care workers (HCW), including 138 nurses and 23 pharmacists, and 86 unexposed non-atopic healthy controls were recruited from a single tertiary hospital and the general population. A questionnaire regarding work-related symptoms was administered along with skin prick tests (SPT) to the three most commonly used cephalosporins (cefotiam, ceftriaxone, and ceftizoxime). Serum specific IgE antibodies to conjugates of the three cephalosporins and human serum albumin (HSA) were measured by enzyme-linked immunosorbent assay (ELISA). Binding specificities were confirmed by ELISA inhibition tests.

Results: The prevalence of work-related symptoms in association with cephalosporins was 17.4%. The sensitization rate to any cephalosporin was 3.1% by SPT. Sensitization rates determined by measurement of serum specific IgE antibodies were 17.4% for any cephalosporin, 10.4% for cefotiam, 6.8% for ceftriaxone, and 3.7% for ceftizoxime. A personal history of any antibiotic allergy was a risk factor for work-related symptoms (OR, 24.93; 95% CI, 2.61-238), but not for the presence of serum specific IgE antibodies to cephalosporins (OR, 0.9; 95% CI, 0.18-4.53). A personal history of atopic dermatitis was a risk factor for the presence of serum specific IgE antibodies to cefotiam-HSA conjugate (OR, 6.30; 95% CI, 1.23-32.3).

Conclusions: A high cephalosporin sensitization rate (17.4%) was detected by ELISA in HCW exposed to cephalosporins. Monitoring of serum specific IgEs to cephalosporin-HSA conjugates will be useful for detecting sensitized subjects.

Keywords: Cephalosporin; IgE; occupational diseases.

Fig. 1

Levels of serum specific IgE antibody to three cephalosporin-human serum albumin (HSA) conjugates in health care workers (•) and unexposed non-atopic healthy controls (○). (A) cefotiam-HSA conjugate. (B) Ceftriaxone-HSA conjugate. (C) Ceftizoxime-HSA conjugate. Horizontal dashed lines indicate cut-off values (mean±three SD). Horizontal bars next to individual plots represent the mean values of each group.

Fig. 2

Results of competitive ELISA inhibition tests for serum specific IgE antibodies to cephalosporin-human serum albumin (HSA) conjugates, free cephalosporins and HSA alone (◇). (A) Inhibition of the cefotiam-HSA conjugate. Significant inhibitions were noted with both conjugated (•) and free (○) cefotiam in dose-dependent manners. (B) Inhibition of the ceftriaxone-HSA conjugate. Significant inhibitions were noted with both conjugated (▴) and free (▵) ceftriaxone in dose-dependent manners. (C) Inhibition of the ceftizoxime-HSA conjugate. Significant inhibitions were noted with both conjugated (▪) and free (□) ceftizoxime in dose-dependent manners.