Allergy Asthma Immunol Res.  2015 May;7(3):301-303. 10.4168/aair.2015.7.3.301.

Immunologic Evaluation of Patients with Cefotetan-Induced Anaphylaxis

• Nam YH
• Hwang EK
• Ban GY
• Jin HJ
• Yoo HS
• Shin YS
• Ye YM
• Nahm DH
• Park HS
• Lee SK

• KMID: 2260469
• DOI: http://doi.org/10.4168/aair.2015.7.3.301

Abstract

Cefotetan is a commonly prescribed second-generation cephalosporin that acts against a wide range of bacteria. However, cefotetan-induced hypersensitivity has rarely been reported. We report 2 cases of cefotetan-induced anaphylaxis with immunologic evaluation. The first case was a 70-year-old asthmatic woman who had dyspnea and hypotension during administration of cefotetan, in which high serum-specific IgE to cefotetan-human serum albumin (HSA) conjugate was detected by enzyme-linked immunosorbent assay. The second case was a 63-year-old asthmatic woman who complained of chest tightness and dyspnea during cefotetan infusion, in which high serum-specific IgG1 and IgG4 with no serum specific IgE to cefotetan-HSA conjugate was detected. The basophil activation test using basophils from the patient showed a significant up-regulation of CD63 with the addition of anti-IgG4 antibody compared with that in non-atopic healthy controls. In conclusion, cefotetan can induce anaphylaxis, which may involve both IgE- and IgG4-mediated responses in the pathogenic mechanism.

Keyword

Anaphylaxis; cefotetan; specific IgE; specific IgG4

MeSH Terms

Aged
Anaphylaxis*
Bacteria
Basophils
Cefotetan
Dyspnea
Enzyme-Linked Immunosorbent Assay
Female
Humans
Hypersensitivity
Hypotension
Immunoglobulin E
Immunoglobulin G
Middle Aged
Serum Albumin
Thorax
Up-Regulation
Cefotetan
Immunoglobulin E
Immunoglobulin G
Serum Albumin

Figure

• 

  Figure Serum-specific IgE (A) and IgG4 (B) to cefotetan in patient 1 (), patient 2 () and healthy controls (▴) as determined by ELISA, as well as the results of basophil activation tests using free cefotetan extracts (C) and anti-IgG4 antibody (D) in patient 2 () and healthy controls (▴). The horizontal bar indicates the mean + 3 SD absorbance values of healthy controls.

Reference

1. Kim JE, Kim SH, Jin HJ, Hwang EK, Kim JH, Ye YM, Park HS. IgE sensitization to cephalosporins in health care workers. Allergy Asthma Immunol Res. 2012; 4:85–91.

2. Suh YJ, Lee YM, Choi JH, Suh CH, Nahm DH, Park HS. Heterogeneity of IgE response to cefteram pivoxil was noted in 2 patients with cefteram-induced occupational asthma. J Allergy Clin Immunol. 2003; 112:209–210.

3. Kim JH, An S, Kim JE, Choi GS, Ye YM, Park HS. Beef-induced anaphylaxis confirmed by the basophil activation test. Allergy Asthma Immunol Res. 2010; 2:206–208.

4. Bloomberg RJ. Cefotetan-induced anaphylaxis. Am J Obstet Gynecol. 1988; 159:125–126.

5. Lee MJ, Lim TH, Lee BJ, Yi JW, Park SH, Choi SK, Park SJ. Anaphylactic reaction to cefotetan during spinal anesthesia: a case report. Korean J Anesthesiol. 2005; 49:861–863.

6. Blanca M, Romano A, Torres MJ, Férnandez J, Mayorga C, Rodriguez J, Demoly P, Bousquet PJ, Merk HF, Sanz ML, Ott H, Atanasković-Marković M. Update on the evaluation of hypersensitivity reactions to betalactams. Allergy. 2009; 64:183–193.

7. Romano A, Guéant-Rodriguez RM, Viola M, Amoghly F, Gaeta F, Nicolas JP, Guéant JL. Diagnosing immediate reactions to cephalosporins. Clin Exp Allergy. 2005; 35:1234–1242.

8. Antúnez C, Martín E, Cornejo-García JA, Blanca-Lopez N, R-Pena R, Mayorga C, Torres MJ, Blanca M. Immediate hypersensitivity reactions to penicillins and other betalactams. Curr Pharm Des. 2006; 12:3327–3333.

9. Finkelman FD. Anaphylaxis: lessons from mouse models. J Allergy Clin Immunol. 2007; 120:506–515.

10. Tsujimura Y, Obata K, Mukai K, Shindou H, Yoshida M, Nishikado H, Kawano Y, Minegishi Y, Shimizu T, Karasuyama H. Basophils play a pivotal role in immunoglobulin-G-mediated but not immunoglobulin-E-mediated systemic anaphylaxis. Immunity. 2008; 28:581–589.

11. Ishizaka A, Sakiyama Y, Nakanishi M, Tomizawa K, Oshika E, Kojima K, Taguchi Y, Kandil E, Matsumoto S. The inductive effect of interleukin-4 on IgG4 and IgE synthesis in human peripheral blood lymphocytes. Clin Exp Immunol. 1990; 79:392–396.

12. de Haan P, Boorsma DM, Kalsbeek GL. Penicillin hypersensitivity. Determination and classification of anti-penicillin antibodies by the enzyme-linked immunosorbent assay. Allergy. 1979; 34:111–119.

13. Nam YH, Kim JE, Kim SH, Jin HJ, Hwang EK, Shin YS, Ye YM, Park HS. Identifying genetic susceptibility to sensitization to cephalosporins in health care workers. J Korean Med Sci. 2012; 27:1292–1299.

14. Adkinson NF Jr, Swabb EA, Sugerman AA. Immunology of the monobactam aztreonam. Antimicrob Agents Chemother. 1984; 25:93–97.

15. Sánchez-Borges M, Thong B, Blanca M, Ensina LF, González-Díaz S, Greenberger PA, Jares E, Jee YK, Kase-Tanno L, Khan D, Park JW, Pichler W, Romano A, Jaén MJ. Hypersensitivity reactions to non beta-lactam antimicrobial agents, a statement of the WAO special committee on drug allergy. World Allergy Organ J. 2013; 6:18.

16. Hausmann OV, Gentinetta T, Bridts CH, Ebo DG. The basophil activation test in immediate-type drug allergy. Immunol Allergy Clin North Am. 2009; 29:555–566.

17. Sanz ML, Gamboa PM, Mayorga C. Basophil activation tests in the evaluation of immediate drug hypersensitivity. Curr Opin Allergy Clin Immunol. 2009; 9:298–304.