Table of Contents
Journal of Allergy
Volume 2011, Article ID 365683, 9 pages
Review Article

Occupational Asthma in Antibiotic Manufacturing Workers: Case Reports and Systematic Review

1Centro Medico de Asturias, Avendia José María Richard, Oviedo, 33193 Asturias, Spain
2Department of Occupational & Environmental Medicine, National Heart & Lung Institute (Imperial College) and Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK

Received 27 November 2010; Accepted 20 January 2011

Academic Editor: Gordon L. Sussman

Copyright © 2011 Sara Díaz Angulo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. The risks of occupational asthma (OA) from antibiotics are uncertain. We report 4 new cases and a systematic review of the literature. Methods. Cases were identified through a specialist clinic, each underwent specific provocation testing (SPT). We subsequently reviewed the published literature. Results. The patients were employed in the manufacture of antibiotics; penicillins were implicated in three cases, in the fourth erythromycin, not previously reported to cause OA. In two, there was evidence of specific IgE sensitisation. At SPT each developed a late asthmatic reaction and increased bronchial hyperresponsiveness. 36 case reports have been previously published, 26 (citing penicillins or cephalosporins). Seven cross-sectional workplace-based surveys found prevalences of 5–8%. Conclusions. OA in antibiotic manufacturers may be more common than is generally recognised. Its pathogenesis remains unclear; immunological tests are of uncertain value and potential cases require confirmation with SPT. Further study of its frequency, mechanisms, and diagnosis is required.