Contact urticaria refers to a wheal-and-flare response after cutaneous exposure to certain chemicals. If contact urticaria is accompanied by systemic symptoms, it is referred to as contact urticaria syndrome. Herein we report two cases of contact urticaria syndrome occur-ring in nurses due to occupational exposure to cefotiam.
Cefotiam ; Occupational Exposure ; Urticaria*

We herein report a case of occupational contact urticaria syndrome induced by cefotiam di-hydrochloride in a nurse. She had generalized pruritic wheals accompanied by palpitations and tachypnea during the preparation of cefotiam solution. A scratch patch test with cefotiam di-hydrochloride, a major component of cefotiam ingredient showed multiple erythema and wheals within 5 minutes, accompanied by palpitations and tachypnea. No delayed type reaction was observed. Based on her clinical history and scratch test result, we diagnosed her condition as contact urticaria syndrome caused by cefotiam.
Cefotiam* ; Erythema ; Patch Tests ; Tachypnea ; Urticaria*

Contact urticaria refers to a wheal-and-flare response which occurs on intact skin after application of a chemical. When contact urticaria is accompanied by systemic symptoms, it is known as the contact urticaria syndrome. We report a case of contact urticaria syndrome occurring in a 24-year-old nurse, due to occupational exposure to cefotiam. An open patch test showed a positive reaction to cefotiam.
Cefotiam ; Humans ; Occupational Exposure ; Patch Tests ; Skin ; Urticaria* ; Young Adult

Contact urticaria refers to a wheal-and-flare response occurring on the application of chemicals to intact skin. When contact urticaria is accompanied by systemic symptoms, it is known as the urticaria syndrome. Fourteen cases of cefotiam-induced contact urticaria have been reported in the foreign literature, but no such case, as far as we know, has been described in the Korean dermatology literature. We report a case of contact urticaria syndrome occurring in a 23-year-old nurse due to occupational contact exposure to cefotiam. She experienced generalized urticaria, itching of the skin, difficulty in breathing, and abdominal pain, when she was preparing an injection of cefotiam. An open patch test showed positive reactions to cefotiam, cefmetazole, and ceftriaxone. Since avoiding cefotiam, the symptoms disappeared and did not recurred.
Abdominal Pain ; Cefmetazole ; Cefotiam ; Ceftriaxone ; Dermatology ; Humans ; Patch Tests ; Pruritus ; Respiration ; Skin ; Urticaria* ; Young Adult

Anaphylaxis caused by beta-lactam antibiotics usually develops following the systemic administration of the drug, although it can also occur with trivial contact of the drug on the skin in extraordinarily sensitive individuals. Cefotiam is a second-generation cephalosporin developed in Japan, and cefotiam-induced contact urticaria and systemic symptoms (contact urticaria syndrome) have been reported in several nurses from Japan and Korea. Considering the serious nature of the systemic manifestations, such as hypotension, contact anaphylaxis is a more appropriate name for severe forms of the disease than contact urticaria syndrome. No previous study has reported a case involving contact urticaria syndrome to multiple drugs. We describe a case of cefotiam-induced contact anaphylactic shock combined with cefoperazone/sulbactam-induced contact urticaria syndrome in a 24-year-old nurse. She exhibited positive skin prick test responses to both cefotiam and cefoperazone/sulbactam.
Anaphylaxis ; Anti-Bacterial Agents ; Cefoperazone ; Cefotiam ; Humans ; Hypotension ; Japan ; Korea ; Skin ; Sulbactam ; Urticaria ; Young Adult

Cephalosporins are B-lactam antibiotics. They are usually bactericidal in action and act by inhibiting mucopeptide synthesis in the bacterial cell wall. Cephalosporins have been used widely in Korea. However, allergic contact dermatitis to cephalosporins has not been reported in the Korean dermatologiy literature. We report a case of allergic contact dermatitis due to cephalosporins in a 23-year-old nurse who suffered from itchy, erythematous patches and plaques with numerous fissures on both hands. A patch test with ceftriaxone and a prick test with cefotiam were positive.
Anti-Bacterial Agents ; Cefotiam ; Ceftriaxone ; Cell Wall ; Cephalosporins* ; Dermatitis, Allergic Contact* ; Hand ; Humans ; Korea ; Patch Tests ; Young Adult

Acute generalized exanthematous pustulosis (AGEP) is initially termed by Beylot to describe a disease entity with sudden onset of amicrobial pustular eruption accompanied with fever and leukocytosis. A 58-year-old man presented with sudden onset of multiple, generally pinhead sized pustules on erythematous base scattered on trunk accompanied with fever. The patient had been on medication of cefotiam prior to skin eruption for 4 days after esophageal cancer operation. Histopathological study of a skin biopsy specimen revealed subcorneal pustules with a few neutrophils and few eosinophils in dermis. After discontinuation of cefotiam and systemic steroid medication for 5 days, the eruption resolved clearly without scars within 4 days.
Acute Generalized Exanthematous Pustulosis* ; Biopsy ; Cefotiam ; Cicatrix ; Dermis ; Eosinophils ; Esophageal Neoplasms ; Fever ; Humans ; Leukocytosis ; Middle Aged ; Neutrophils ; Skin

No abstract available.
Anti-Bacterial Agents/therapeutic use ; Cefotaxime/therapeutic use ; Cefotiam/therapeutic use ; Humans ; Infant ; Male ; Republic of Korea/epidemiology ; Salmonella/*isolation & purification ; Salmonella Infections/*diagnosis/drug therapy/epidemiology

A 41-year-old male pharmaceutical worker developed dyspnea and wheezing 10 years after beginning the work. He had handled powder of cephalosporin precursor, 7-aminocephalosporanic acid (7-ACA). He had suffered from dyspnea, chest tightness and wheezing in the workplace for the last three years. Recently, these symptoms were aggravated. His pulmonary function test showed severe obstructive pattern and PC(20) was 0.06 mg/ml on MBPT(methacholine bronchial provocation test). Skin prick test and intradermal test showed positive reactions to ceftriaxone, cefazolin, etc. During the skin test, he suffered from an asthmatic attack and anaphylactic shock. Bronchial provocation test with cefotiam elicited a dual asthmatic reaction. We presumed that IgE-mediated mechanism may be mainly involved in the pathogenesis of cephalosporin induced occupational asthma, in addition to other immunologic or non-immunologic mechanisms. Further studies will be necessary to investigate the pathogenesis of this disease.
Adult ; Anaphylaxis ; Asthma, Occupational* ; Bronchial Provocation Tests ; Cefazolin ; Cefotiam ; Ceftriaxone ; Dyspnea ; Humans ; Intradermal Tests ; Male ; Respiratory Function Tests ; Respiratory Sounds ; Skin ; Skin Tests ; Thorax

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.
Anaphylaxis ; Antibodies ; Asthma ; Cefotiam ; Ceftizoxime ; Ceftriaxone ; Cephalosporins ; Delivery of Health Care ; Dermatitis, Atopic ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypersensitivity ; Immunoglobulin E ; Occupational Diseases ; Pharmacists ; Prevalence ; Risk Factors ; Serum Albumin ; Skin ; Tertiary Care Centers ; Urticaria ; Surveys and Questionnaires