Occupational asthma and IgE sensitization in a pharmaceutical company processing cefteram pivoxil

Abstract

BACKGROUND: 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. After investigation of one worker with occupational asthma due to cefteram pivoxil (cefteram), all 33 employed workers of a pharmaceutical company processing cefteram were investigated to determine the prevalence, risk factors of occupational asthma and IgE sensitization to cefteram. METHODS: A standardized questionnaire, skin prick test (SPT) to eight common aeroallergens, possible causal agents, and related causal agents, pulmonary function test, total IgE, complete blood count including eosinophil count were performed. Methacholine and cefteram-specific bronchoprovo-cation test (BPT) were performed in patients with symptoms or a positive SPT. Serum specific IgE to cefteram-HSA conjugate were detected by ELISA. Twenty-one patients with no history of exposure to cefteram and negative SPT to common aeroallergens and cefteram were used as controls. RESULTS: 13 (39.4%) out of 33 workers complained of work-related symptoms of asthma and/or rhinitis according to the questionnaire. Four of 33 workers (12.1%) showed positive responses on SPT. Serum specific IgE to cefteram-HSA conjugate was detected in 14 (42.4%) of 33 workers. Serum specific IgE level of the exposed workers was significantly higher than controls (p < 0.05). Seven (21.2%) asymptomatic sensitized subjects were noted. Two patients showed an early asthmatic response to BPT with cefteram. Both patients complained of asthma symptoms, showed positive responses on SPT, and had high serum specific IgE to cefteram. CONCLUSION: Positive responses on SPT, significant bronchoconstriction on BPT and the detection of specific IgE by ELISA suggests that cefteram pivoxil powder inhalation can induce IgE-mediated bronchoconstriction and that serum specific IgE may be used as a useful marker to screen susceptible individuals.