Food‐dependent exercise‐induced anaphylaxis in the celery‐mugwort‐birch‐spice syndrome

Abstract

Several commonly prescribed cephalosporins or cephalosporin derivatives including cefaclor, cefotaxime, 7-ACA and 7-ADCA could induce occupational asthma and rhinitis which were sensitized via inhalation route in nurses or pharmaceutical industry workers (5, 6), while the most common clinical symptoms with cefotiam induced occupational allergy were contact urticaria or anaphylaxis, not respiratory allergies (1-3).This study is the first to succeed to detect serum-specific IgE to cefotiam-HSA conjugate by ELISA, which binding specificity was confirmed by ELISA inhibition test.As significant inhibitions were noted by both free cefotiam and cefotiam-HSA conjugate, we can speculate that the pathogenic mechanism is derived from IgE response to hapten part of cefotiam.We also detected serum-specific IgG4 antibody to cefotiam-HSA conjugate in serum of the patient with minimal bindings in controls' sera (data not shown).Further studies will be needed to understand the role of serum-specific IgG4 antibody in cefotiam induced occupational allergy.Considering that IgE sensitization can be possible through skin contact to low concentration of cefotiam exposure, this ELISA system will be useful for screening the asymptomatic sensitized subjects or early detection of occupational allergy subjects.In conclusion, we report a case of severe occupational urticaria and anaphylaxis caused by skin contact to cefotiam in a nurse, which was mediated by specific IgE mechanism to the hapten part.