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Heterogeneity of the IgE response to allergenic determinants of cefaclor in serum samples from patients with cefaclor-induced anaphylaxis.

Kim, SH; Choi, JH; Park, HS
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 94(6):700-704, 2005
Journal Title
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
BACKGROUND: Beta-lactam antibiotics, such as cefaclor, may cause IgE-mediated anaphylactic reactions. However, the clinically available serologic test has not been widely accepted, and the antigenic determinants of these drugs are unclear.

OBJECTIVE: To describe 4 cases of anaphylaxis caused by cefaclor in which a specific IgE response to cefaclor was demonstrated.

METHODS: Four patients with anaphylaxis to cefaclor and 35 nonatopic controls never exposed to cefaclor were studied. Skin tests and oral challenges with this drug were performed. The specific IgE response to the antigenic determinant of cefaclor-human serum albumin (HSA) conjugate was compared in each patient. The serum specific IgE to cefaclor-HSA conjugate was detected using enzyme-linked immunosorbent assay (ELISA). Also, ELISA inhibition studies using various concentrations of cefaclor-HSA, HSA alone, and free cefaclor were performed, as were hapten inhibition studies using cefaclor, cephalexin, cefadroxil, ampicillin, ceftriaxone, and cefotaxime.

RESULTS: Three patients showed high levels of serum specific IgE to cefaclor-HSA and marked inhibition patterns to free cefaclor and cefaclor-HSA conjugate on ELISA inhibition testing. Hapten inhibition testing in 3 individual serum samples showed 2 different patterns. In patient 3, significant dose-dependent inhibitions (up to 92%) were noted with additions of free cefaclor and cefaclor-HSA conjugate, and lesser inhibitions (up to 74%) were noted with cephalexin, which shares the aminobenzyl side chain. In patients 1 and 2, marked dose-dependent inhibitions were noted only with additions of cefaclor-HSA conjugate and free cefaclor, whereas minimal inhibitions were noted with the other 5 compounds.

CONCLUSIONS: The specific IgE response to cefaclor-HSA conjugate in patients with cefaclor anaphylaxis occurs against the hapten, in which heterogeneity of the antigenic determinant was noted to depend on the individual.
MeSH terms
AdolescentAdultAnaphylaxis/chemically induced*Anaphylaxis/immunology*Anti-Bacterial Agents/adverse effects*Anti-Bacterial Agents/immunology*Cefaclor/adverse effects*Cefaclor/immunology*Enzyme-Linked Immunosorbent AssayEpitopes/immunologyFemaleHaptens/immunologyHumansImmunoglobulin E/blood*Male
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Journal Papers > School of Medicine / Graduate School of Medicine > Allergy
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박, 해심
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