This is the first reported detection of serum IgE antibody to piperacillin-human serum albumin (HSA) conjugate in a patient presenting with anaphylaxis that developed after occupational exposure. A 24-yr-old nurse, who had worked at a University Hospital for 2 yr, experienced chest tightness, dizziness, generalized urticaria, abdominal pain, and diarrhea 10 min after administering a piperacillin injection. She had previously suffered from atopic dermatitis. A skin prick test for common inhalant allergens was entirely negative; in contrast, her serum total IgE was elevated (283 IU/mL). A high level of piperacillin-specific serum IgE was detected by ELISA using piperacillin-HSA conjugate. Significant inhibition upon addition of both free piperacillin and piperacillin-HSA conjugate was detected by inhibition ELISA. These data suggest that piperacillin exposure in the workplace can induce occupational anaphylaxis and urticaria mediated by an interaction of IgE with the hapten of piperacillin.
Anaphylaxis/*chemically induced/immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Hospitals, University ; Humans ; Immunoglobulin E/*blood/immunology ; Intensive Care Units ; Occupational Diseases/*chemically induced/immunology ; *Occupational Exposure ; Piperacillin/*immunology ; Serum Albumin/*immunology ; Urticaria/immunology ; Young Adult

We experienced a case of immunoglobulin E (IgE) mediated anaphylaxis to levodropropizine. The patient was an 18-year old Korean woman. After taking the common cold medication including acetaminophen, domperidone, and levodropropizine, skin rash, angioedema and anaphylaxis were developed immediately. As she was tolerable to acetaminophen alone, we thought the culprit agent was maybe a levodropropizine tablet. To confirm the culprit, she underwent skin prick test and oral drug provocation test with the suspected one. Finally we detected levodropropizine specific IgE and confirmed the specificity by inhibition enzyme-linked immunosorbent assay (ELISA).
Adolescent ; Anaphylaxis/*chemically induced/*immunology ; Antitussive Agents/*adverse effects ; Bronchial Provocation Tests ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin E/*immunology ; Propylene Glycols/*adverse effects ; Skin Tests

PURPOSE: Cefaclor is widely prescribed for various infectious diseases. As its consumption increases, the number of hypersensitivity reactions to cefaclor has increased. This study aimed to evaluate the immunologic findings of immediate hypersensitivity to cefaclor. MATERIALS AND METHODS: We enrolled 47 patients with immediate hypersensitivity to cefaclor from Ajou University Hospital and Asan Medical Center. Serum specific IgE, IgG1, and IgG4 antibodies to cefaclor-human serum albumin (HSA) conjugate were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: The most common phenotype was anaphylaxis (Group I, 78.7%), followed by urticaria (Group II, 21.3%). The detection of specific IgE, IgG1, and IgG4 to cefaclor-HSA conjugate by ELISA tended to be higher in Group I (40.5%, 41.7%, 21.6%) than in Group II (20.0%, 20.0%, 0%) with no statistical significance. Significant associations were found between specific IgE and IgG1 or IgG4 (p<0.001, p=0.019). ELISA inhibition tests showed significant inhibitions by both free cefaclor and cefaclor-HSA conjugate. For basophil activation tests in patients having no specific IgE antibody, the CD63 expression level on basophils increased with incubations of free cefaclor. CONCLUSION: The most common manifestation of immediate hypersensitivity to cefaclor was anaphylaxis, most of which was mediated by IgE; however, a non-IgE mediated direct basophil activation mechanism was suggested in a subset of anaphylaxis patients.
Adolescent ; Adult ; Aged ; Anaphylaxis/*chemically induced/immunology ; Anti-Bacterial Agents/adverse effects/*immunology ; Antigens, CD63 ; Basophils/metabolism ; Cefaclor/*adverse effects/immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Hypersensitivity, Immediate/chemically induced/diagnosis/*immunology ; Immunoglobulin E/*blood ; Immunoglobulin G/immunology ; Male ; Middle Aged ; Retrospective Studies ; Skin Tests ; Urticaria/chemically induced/diagnosis/immunology ; Young Adult

OBJECTIVETo investigate the relationship between specific immunocyte and pseudoanaphylactoid reactions (PR) induced by Shuanghuanglian injection (SHLI).

METHODICR mice, SCID mice and BALB/C athymic mouse were divided into different test groups, the mice were intravenously injected with solutions of different concentration of SHLI, positive control Compound 48/80 and normal sodium. All test substances were mixed with 0. 4% Evans blue. The reaction and vascular permeability of the ears were observed and measured 30 min after SHLI injected.

RESULTSHLI of 300, 600 mg x kg(-1) caused obvious vascular hyperpermeability in ICR mice, but the same dose of SHLI didn't cause vascular hyperpermeability in SCID mice and BALB/C athymic mouse.

CONCLUSIONSHLI in equivalent and 2 times the clinical dose can cause PR in ICR mice, but the same dose of SHLI can't cause PR in SCID mice and BALB/C athymic mouse, so specific immunocyte maybe take part in the SHLI-induced PR.

Anaphylaxis ; chemically induced ; immunology ; Animals ; Drugs, Chinese Herbal ; toxicity ; Immune System ; drug effects ; Injections ; methods ; Mice ; Mice, Inbred BALB C ; Mice, Inbred ICR ; Mice, SCID

OBJECTIVETo investigate the preclinical evaluation method of pseudoanaphylactoid reactions for Chinese herbal injections.

METHODBeagle dogs were divided into control group (C), 0.5% tween 80 group (T), Yuxincao injection containing 0.5% tween 80 (YT), distilled solution from Yuxincao (Y). Various groups of Beagle dogs were given 3 mL x kg(-1) of the test articles intravenously. The anaphylactoid reactions were observed immediately, while blood pressure, respiratory frequencies and heart rates were tested at 10 min and 30 min after administration.

RESULTA variety of symptoms that range from cutaneous and mucosa signs to bronchospasma and cardiovascular collapse, including angioedema at lip, conjunctiva, ear and circumoral skin, somnolence, lethargy, breathless or dyspnea, severe hypotension etc were observed in T and TY groups from immediately post-injection to at least 30 min after administration. These reactions occurred at both first injection or repeated injections at 24 weeks intervals, manifesting that it was pseudoanaphylactoid reaction mediated by non-immune mechanisms.

CONCLUSIONBeagle dogs could be used as an animal model for preclinical evaluation of pseudoanaphylactoid reactions of Chinese herbal injection with sensitivity, reproducibility, and high clinic consistency.

Anaphylaxis ; chemically induced ; etiology ; immunology ; Animals ; Dogs ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; Injections, Intravenous ; Male ; Models, Animal ; Random Allocation

Reviewing the progress on study about the major allergen of Shuanghuanglian injection in recent years, resulted in that individual differences of anaphylactic shock are closely related with HLA gene polymorphism. Basing on this, we put forward the research strategy on susceptibility gene of important allergen of Shuanghuanglian injection based on the theory of genetic fingerprints, in order to make sure about the relationship the major allergen of Shuanghuanglian injection and HLA-DRB gene polymorphism and specificity IgE antibody, and to clarify the allergic reaction loci reduced allergic reactions, which can provide the reference data for the study on mechanisms for anaphylactic reaction of Shuanghuanglian injection, and research ideas for the sensitization mechanism of traditional Chinese medicine injection study.
Allergens ; adverse effects ; Anaphylaxis ; chemically induced ; genetics ; immunology ; Drugs, Chinese Herbal ; adverse effects ; Genetic Predisposition to Disease ; genetics ; HLA-DR Antigens ; genetics ; HLA-DRB1 Chains ; Humans ; Immunoglobulin E ; immunology ; Injections ; Polymorphism, Genetic ; genetics

Both immediate and delayed hypersensitivity reactions to iodinated contrast media (ICM) are relatively common. However, there are few data to determine the clinical utility of immunologic evaluation of ICM. To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity, 23 patients (17 immediate and 6 delayed reactions) were enrolled from 3 university hospitals in Korea. With 6 commonly used ICM including iopromide, iohexol, ioversol, iomeprol, iopamidol and iodixanol, skin prick (SPT), intradermal (IDT) and patch tests were performed. Of 10 patients with anaphylaxis, 3 (30.0%) and 6 (60.0%) were positive respectively on SPTs and IDTs with the culprit ICM. Three of 6 patients with urticaria showed positive IDTs. In total, 11 (64.7%) had positive on either SPT or IDT. Three of 6 patients with delayed rashes had positive response to patch test and/or delayed IDT. Among 5 patients (3 anaphylaxis, 1 urticaria and 1 delayed rash) taken subsequent radiological examinations, 3 patients administered safe alternatives according to the results of skin testing had no adverse reaction. However, anaphylaxis developed in the other 2 patients administered the culprit ICM again. With 64.7% (11/17) and 50% (3/6) of the sensitivities of corresponding allergic skin tests with culprit ICM for immediate and delayed hypersensitivity reactions, the present study suggests that skin tests is useful for the diagnosis of ICM hypersensitivity and for selecting safe ICM and preventing a recurrence of anaphylaxis caused by the same ICM.
Anaphylaxis/chemically induced/diagnosis/immunology ; Contrast Media/*adverse effects ; Cross Reactions/immunology ; Dermatitis, Contact/*diagnosis/*immunology ; Drug Hypersensitivity/diagnosis ; Female ; Humans ; Iodides/*immunology ; Iohexol/analogs & derivatives ; Iopamidol/analogs & derivatives ; Male ; Middle Aged ; Republic of Korea ; Skin Tests/*methods ; Triiodobenzoic Acids ; Urticaria/diagnosis/immunology

This study is to establish a rat chronic asthma model. Sensitive SD rats were selected through histamine challenge. The asthmatic groups were sensitized by ih and ip with OVA, aluminium hydroxide gel and inactivated bacillus pertussis on day 1 and 14. From day 21, acute asthmatic group was aerosolized 1% OVA for 1 week, chronic asthmatic group was aerosolized 0.1% OVA for 12 weeks. The control groups received saline as the substitution of OVA. Twenty four hours after the last provocation, physiological monitoring equipment was used to detect the pulmonary function, then the rats were sacrificed. Bronchoalveolar lavage fluid (BALF) was collected to calculate the ratio of different inflammatory cells. ELISA was used to detect total IgE and OVA-specific IgE in serum. Microscopy was conducted to observe the histopathology of lung stained with haematoxylin and eosin staining. Collagen fibers were detected using Picric acid-Sirius red staining technique. The optical density at 610 nm of extractive from locus caeruleus was detected by passive cutaneous anaphylaxis (PCA). The results showed that the asthmatic characteristics were significantly developed in model groups, but not in control groups. Chronic asthmatic group had significantly higher indexes than acute asthmatic group, including the thickness of airway smooth muscle and bronchial basement membrane, and goblet cell hyperplasia, the area of collagen in airways, A610 of extractive from locus caeruleus, the concentration of total IgE and OVA-specific IgE in serum. However, inflammatory cell infiltrate in lungs and the percentage of eosinophils of white blood cells in BALF were lower in chronic asthmatic group than those in acute asthmatic group. Respiratory rate and respiratory flow showed no significant difference in both model groups. In conclusion, the rat chronic asthma model is established by the way in this study, which is comparable to the physiopathologic characteristics of human asthma.
Airway Remodeling ; Animals ; Asthma ; blood ; chemically induced ; pathology ; physiopathology ; Bronchoalveolar Lavage Fluid ; cytology ; Chronic Disease ; Disease Models, Animal ; Eosinophils ; pathology ; Female ; Immunoglobulin E ; blood ; Leukocyte Count ; Lung ; pathology ; Ovalbumin ; immunology ; Passive Cutaneous Anaphylaxis ; Pulmonary Ventilation ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Respiratory Rate

OBJECTIVETo determine the relation between the change of immunotoxicology indexes of serum and the occurrence of anaphylaxis in patients induced by Qingkailing injection, which is composed by cholic acid, mother-of-pearl, gardenia, cornu bubali, isatis root, baicalin, honeysuckle, and to establish the method of detection of the type of anaphylaxis in patients induced by traditional Chinese medicine (TCM) injection.

METHODIn a prospective nested case-control study, we compared the concentration of IgE, IgG, IL-4, histamine of 18 cases in anaphylaxis induced by Qingkailing injection with those from 72 matched controls who remained normal after the using Qingkailing injection. The correlation between the change of IgE, IgG, IL-4, histamine of serum and the occurrence of anaphylaxis in patients induced by Qingkailing injection was determined, and we also evaluate the clinical values of IgE, IgG, IL-4, histamine of serum in diagnosis of anaphylaxis in patients induced by Qingkailing injection by receiver operating characteristic (ROC) curves.

RESULTThe concentrations of IgE, IgG, IL-4, histamine of serum of 18 cases were significantly higher than those in controls (P<0.05), the area under the curve (AUC) of IL-4, IgG, IgE, histamine were 0.362 (95.0% CI. for EXP was 0.978-2.405), 0.349 (95.0% CI. for EXP was 1.448-316.232), 0.350 (95.0% CI. for EXP was 1.262-601.306), 0.374 (95.0% CI. for EXP was 1.003-45.413), respectively.

CONCLUSIONThe allergic reaction caused by Qingkailing injection may be due to type I allergic reactions; The presence of IgE, IgG, IL-4, Histamine can serve as clinical evaluation indicators in evaluation the damage degree of immune system caused by anaphylaxis in patients induced by Qingkailing injection. Cytokines are more likely to become the effective evaluation index in diagnosis of anaphylaxis in patients induced by TCM injection.

Adult ; Anaphylaxis ; chemically induced ; diagnosis ; immunology ; Animals ; Case-Control Studies ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Histamine ; metabolism ; Humans ; Immunoglobulin E ; blood ; drug effects ; Immunoglobulin G ; blood ; drug effects ; Injections ; Interleukin-4 ; blood ; metabolism ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Prospective Studies