Yonsei Med J.  2014 Nov;55(6):1473-1483. 10.3349/ymj.2014.55.6.1473.

Immunologic Evaluation of Immediate Hypersensitivity to Cefaclor

• Yoo HS
• Kim SH
• Kwon HS
• Kim TB
• Nam YH
• Ye YM
• Park HS

• KMID: 2070193
• DOI: http://doi.org/10.3349/ymj.2014.55.6.1473

Abstract

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.

Keyword

Cefaclor; hypersensitivity; immediate; IgE; IgG; anaphylaxis; urticaria

MeSH Terms

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
Anti-Bacterial Agents
Antigens, CD63
Cefaclor
Immunoglobulin E
Immunoglobulin G

Figure

• 

  Fig. 1 Specific IgE (A), IgG1 (B), and IgG4 (C) bindings to cefaclor-human serum albumin by ELISA in sera from Group I (anaphylaxis) and II (urticaria) compared to normal controls (NC). The line, the cutoff value defined as mean+3 standard deviation of the absorbance value of controls. ELISA, enzyme-linked immunosorbent assay; HSA, human serum albumin.

• 

  Fig. 2 IgE (A), IgG1 (B), and IgG4 (C)-ELISA inhibition results of cefaclor-human serum albumin (HSA) coated wells with serial additions of cefaclor-HSA and free cefaclor. NHS, N-hydroxysulfosuccinimide; ELISA, enzyme-linked immunosorbent assay.

• 

  Fig. 3 IgE-ELISA inhibition results of cefaclor-human serum albumin coated wells with serial additions of free cephalosporins and penicillin and aminopenicillin in two different patients with cefaclor-hypersensitivity.

• 

  Fig. 4 The change in the expression of CD63 on basophils after incubation with free cefaclor in the patient (♦: without detection of specific IgE and IgG to cefaclor) and normal controls [atopic (■), non-atopic (▲)]. SI, stimulation index; NC, normal controls.

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