Review Article

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

Table 2

Published cases of occupational allergy to antibiotics 1953–2009.

Penicillins

ReferenceYearCountryNo.ExposureLatencyRespiratory symptomsSkin testSpecific IgEBronchial provocation testOral challenge

[7]1953USA2penicillin#1: “weeks”
#2: 1 year
#1: cough, rhinitis
#2: cough, rhinitis, wheeze
Procaine penicillin (+)not reportednot reportednot reported
[8]1957France4penicillin#1: “years”
#2: 3 months
#3: 1 year
#4: 1 year
#1: cough, rhinitis, dyspnoea
#2: dyspnoea, eczema
#3: dyspnoea
#4: asthma, dyspnoea, eczema
not reportednot reportednot reportednot reported
[9]1960France2penicillin#1: 1 year
#2: 7 years
#1: asthma, urticaria
#2: asthma
#1: PMP* (+)
#2: penicillin (+)
not reportednot reportednot reported
[10]1974UK3ampicillin
BP*
6 APA*
#1: 2 years
#2: 2 years
#3: 2 years
asthma ( )
rhinitis ( )
eczema ( )
conjunctivitis ( )
ampicillin (−)
ampicillin polymer (−)
BPP* (−)
MDM* (−)
not reported#1: ampicillin (+LR*)6APA* (+/−)
#2: ampicillin (+LR*)
BP*(+LR*)
commercial 6APA* (+LR*)
purified 6APA* (−)
BPP* (−)
#3: ampicillin (+LR*)
BP* (+LR*)
6APA* (−)
#1: ampicillin (−)
#2: ampicillin (+LR*) and intestinal symptoms
#3: BP* (+ER*) and urticaria
[11]1980Spain2amoxicillin
ampicillin
#1: 1 year
#2: 1 year
#1: rhinitis, dyspnoea, wheeze
#2: cough, wheeze
not reportednegativenot reportednot reported
[12]1982Germany1ampicillinNS*cough, rhinitis, dyspnoea, feverampicillin (−)BPP* (+)antibiotic mix (+LR*)not reported
[13] ne1997Belgium1amoxicillin6 monthscough, wheeze, rhinitisnot reportednot reportedamoxicillin (+ER* LR*)not reported
[14]1998Spain1amoxicillin27 yearscough, rhinitis, wheeze, dyspnoeaamoxicillin (−)
ampicillin (−)
BP* (−)
BPP* (−)
MDM* (−)
amoxicillin (+)
ampicillin (−)
(penicillin V (−)
amoxicillin: (+ER*)
penicillin V (−)
amoxicillin (+LR*)
penicillin V (−)

Cephalosporins

ReferenceYearCountryNo.ExposureLatencyAllergic symptomsSkin testSpecific IgEBronchial provocation testOral challenge

[11]1980Spain1cephalexin,3 monthscough, wheezePP* (−)
penicillin G (−)
negativenot reportedcephalosporin (NS) (+) and rhinitis, urticaria
[15]1981UK27ACA*
7CTD*
#1: NS*
#2: 10 years
#1: cough, rhinitis, chest tightness
#2: chest tightness, dyspnoea
#1: 7ACA (+)
7CTD (+)
cefalexin (−)
#2: cephalexin (+)
not reported#1: 7ACA (+ER*)
7CTD (+ER*)
cephalexin (−)
#2: cephalexin (+ER*)
not reported
[16]1995UK1ceftazidime1 yearrhinitis, dyspnoeanot reportednot reportedceftazidime (+ER* LR*)not reported
[17]1996Italy1cefmetazole
7-ACA*
1 yearcough, rhinitis, bronchospasmcefmetazole (−)
7-ACA* (−)
penicillin G (−)
penicillin V (−)
cefmetazole (+NS*)
7-ACA (+NS*)
not reported
[18]1999Spain1cefadroxil9 monthscough, rhinitis, dyspnoea, chest tightnessPP* (−)
MDM* (−)
BP* (−)
amoxicillin (−)
cefadroxil (−)
penicillin G (−)
penicillin V (−)
amoxicillin (−)
ampicillin (−)
cefaclor (−)
cefadroxil (+ER*)amoxicillin (−)
cephalexin (+ER*)
[19]2003Korea2cefteramNS*NS*#1: cefteram (+)
#2: cefteram (+)
#1: cefteram-HSA* (+)
#2: cefteram-HSA* (+)
#1: cefteram (+ER*)
#2: cefteram (+ER*)
not reported
[20]2004Korea27-ACA*
ceftriaxone
2 years#1: rhinitis, respiratory symptoms
#2: rhinitis, respiratory symptoms
#1: 7-ACA* (+)
ceftriaxone (+)
#2: 7-ACA* (−)
ceftriaxone (−)
#1: 7-ACA-HSA* (+)
#2: 7-ACA-HAS* (−)
#1: 7-ACA* (+ER*)
ceftriaxone (−)
#2: 7-ACA* (+NS*)
ceftriaxone (−)
not reported
[21]2009Italy17-TACA*
Cephalosporins
8 monthscough, rhinitis, dyspnoeanot reportednot reported7-TACA*: (+ER*)not reported

Miscellaneous

ReferenceYearCountryNo.ExposureLatencyAllergic symptomsSkin testSpecific IgEBronchial provocation testOral challenge

[22]1977India1tetracycline1 yearcough, wheeze, dyspnoeanot reportednot reportedtetracycline (+ER*)tetracycline (+ER*) and urticaria
[23]1975UK1spiramycin1 yearcough, rhinitis, dyspnoea, dermatitisspiramycin (+)not reportedspiramycin (+LR*)not reported
[24]1979Italy1spiramycin1 yearcough, asthma, dermatitisspiramycin (+)not reportedchick feed with spiramycin (+LR*)not reported
[25]1984Italy2spiramycin
adipid acid
#1:14 years
#2:7 months
#1: dyspnoea
#2: cough, dyspnoea
not reportednot reported#1: spiramycin adipate (+ER* LR*)
#2: spiramycin adipate (+ER*)
spiramycin base (+ER* LR*)
not reported
[26]1995Italy1piperacillin22 monthsrhinitis, dyspnoea, wheeze, rashpiperacillin (+)not reportedpiperacillin (+ER*)not reported
[27]2006Korea2thiamphenicolNS*#1: rhinitis, asthma
#2: rhinitis, asthma
#1: thiamphenicol (+)
#2: thiamphenicol (+)
#1: thiamphenicol (+)
#2 thiamphenicol (+)
#1: thiamphenicol (+ER*)
#2: thiamphenicol (+ER*)
not reported
[28]2009Korea1vancomycin5 monthsrhinitis, chest tightnessvancomycin (−)vancomycin-HSA* (−)not reportednot reported
[29]2010Spain1colomycin3 monthsrhinitis, cough, wheeze, dyspnoeanot reportednegativecolomycin (+ER*)not reported

*NS: not specified, *ER: early (asthmatic) response, *LR: late (asthmatic) response.
*HSA: human serum albumin, *MDM: minor determinant (penicillin) mix, *BP: benzylpenicillin.
*(B)PP: (benzyl)penicilloyl polylysine, *PMP: phenoxymethyl penicillin, *6APA: 6 amino penicillanic acid, *7-ACA: 7aminocephalosporanic acid, *7CTD: tosylate dihydrate derivative of 7ACA.
*7-TACA: 7-amino-3thiometihyl-3-cephalosporanic acid.