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

Affiliations
  • 1Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea. skleeai@dau.ac.kr
  • 2Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
  • 3Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.

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.


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