Yonsei Med J.  2018 Oct;59(8):968-974. 10.3349/ymj.2018.59.8.968.

Proper Cut-off Levels of Serum Specific IgE to Cefaclor for Patients with Cefaclor Allergy

• Nam YH
• Lee SH
• Rhyou HI
• Lee YS
• Park SH
• Lee YH
• Shin YS
• Park HS
• Ye YM

• KMID: 2419731
• DOI: http://doi.org/10.3349/ymj.2018.59.8.968

Abstract

PURPOSE
Cefaclor, a second-generation oral cephalosporin, is known to cause IgE-mediated hypersensitivity. Assays of serum-specific IgE (sIgE) to cefaclor are commercially available via the ImmunoCAP system (Thermo Fisher Scientific). While serum levels of sIgE >0.35 kU/L are considered indicative of an allergy, some patients with cefaclor allergy show low serum IgE levels. This study aimed to evaluate the proper cut-off levels of sIgE in the diagnosis of immediate hypersensitivity to cefaclor.
MATERIALS AND METHODS
A total of 269 patients with drug allergy history, who underwent assays of sIgE to cefaclor at Ajou University hospital and Dong-A University Hospital, were reviewed retrospectively. Among them, 193 patients exhibited cefaclor-induced immediate hypersensitivity with certain or probable causality of an adverse drug reaction according to the WHO-UMC (the World Health Organization-the Uppsala Monitoring Centre) algorithm, and 76 controls showed delayed hypersensitivity reactions to non-antibiotics.
RESULTS
In total, 126 of the 193 patients (65.3%) experienced anaphylaxis; they had higher serum sIgE levels than patients with immediate hypersensitivity who did not experience anaphylaxis (6.36±12.39 kU/L vs. 4.28±13.61 kU/L, p < 0.001). The best cut-off value for cefaclor-induced immediate hypersensitivity was 0.11 kU/L, with sensitivity of 80.2% and specificity of 81.6%. A cut-off value of 0.44 kU/L showed the best sensitivity (75.4%) and specificity (65.7%) for differentiating anaphylaxis from immediate hypersensitivity reactions.
CONCLUSION
Patients with cefaclor anaphylaxis exhibit high serum IgE levels. A cut-off value of 0.11 kU/L of sIgE to cefaclor is proper for identifying patients with cefaclor allergy, and 0.44 kU/L may be useful to detect anaphylaxis.

Keyword

Anaphylaxis; cefaclor; drug hypersensitivity; specific IgE

MeSH Terms

Anaphylaxis
Cefaclor*
Diagnosis
Drug Hypersensitivity
Drug-Related Side Effects and Adverse Reactions
Global Health
Humans
Hypersensitivity*
Hypersensitivity, Delayed
Hypersensitivity, Immediate
Immunoglobulin E*
Retrospective Studies
Sensitivity and Specificity
Cefaclor
Immunoglobulin E

Figure

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  Fig. 1 Selection of study subjects.

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  Fig. 2 Levels of serum sIgE to cefaclor according to clinical phenotypes of cefaclor hypersensitivity. sIgE, specific IgE.

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  Fig. 3 ROC curves for determining immediate hypersensitivity to cefaclor (A) and discriminating anaphylaxis among patiens with cefaclor hypersensitivity (B). sIgE, specific IgE; CI, confidence interval; AUC, area under the curve; ROC, receiver operating characteristic.

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