Occupational asthma and IgE sensitization induced by inhalation of cefteram pivoxil powder

Abstract

Cephalosporins are well-known agents that may cause occupational asthma and there have been a few reports suggesting that the pathogenesis may be IgE-mediated. To the best of our knowledge, this is the first report of cefteram pivoxil-induced occupational asthma and detection or serum specific IgE to cefteram-HSA (human serum albumin) conjugate. A 28-year-old woman who had been occupied in a pharmaceutical company for 3 years began to experience rhinorrhea, nasal obstruction, cough, and dyspnea one year after she started work. She was involved in the filling of vials with cefteram pivoxil powder. The patient had no history of previous allergies. Skin prick test (SPT) to 80 common allergens showed negative responses and methacholine bronchoprovocation test (BPT) showed a positive response after inhalation of 0.15 ㎎/㎖. Skin prick test with cefteram pivoxil showed a strong positive response and specific BPT with cefteram demonstrated an early asthmatic response. Serum specific IgE to cefteram-HSA conjugate was detectable by ELISA. In conclusion, an IgE-mechanism may be involved in the pathogenesis of cefteram pivoxil-induced bronchoconstriction in an exposed patient. Further studies will be needed to investigate if serum sIgE may be used as a useful marker to screen susceptible individuals.