ABSTRACT
BACKGROUND: Topical medicaments are a common cause of allergic contact dermatitis. This study will evaluate the prevalence of contact allergy to a wide array of topical medicaments at the Ottawa Patch Test Clinic. OBJECTIVES: The objectives of this study are to report the results of positive patch testing to topical medicaments at the Ottawa Patch Test Clinic and identify common sensitizers in topical medicaments. METHODS: Patients were tested with the standard North American Contact Dermatitis screening series of 70 allergens plus supplementary allergens when indicated. A retrospective chart review of patients positive to topical medicaments between January 1, 2000, and September 30, 2010, was undertaken. RESULTS: The average age of patients was 49.5 years. Thirty-four percent were atopic. Common sensitizers included topical antibiotics (58%), steroids (30%), anesthetics (6%), and antifungals (6%). Patch testing showed that 61% of patients tested positive to antibiotics, 21% to topical steroids, 17% tested positive to topical anesthetics, and 1% tested positive to topical antifungals. The most common reactions were to bacitracin (44%) and neomycin (29%). The most common steroid screener was tixocortol-17-pivalate (group A) (19%), and the most common local anesthetic was lidocaine (12%). CONCLUSIONS: Topical medicaments of all kinds are common causes of allergic contact dermatitis. Those that are more readily available, in over-the-counter preparations, are the most frequent culprits.
Subject(s)
Dermatitis, Allergic Contact/etiology , Drug Eruptions/etiology , Administration, Topical , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/immunology , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Anesthetics, Local/immunology , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/immunology , Antifungal Agents/administration & dosage , Antifungal Agents/adverse effects , Antifungal Agents/immunology , Bacitracin/administration & dosage , Bacitracin/adverse effects , Bacitracin/immunology , Female , Humans , Hydrocortisone/administration & dosage , Hydrocortisone/adverse effects , Hydrocortisone/analogs & derivatives , Hydrocortisone/immunology , Lidocaine/administration & dosage , Lidocaine/adverse effects , Lidocaine/immunology , Male , Middle Aged , Neomycin/administration & dosage , Neomycin/adverse effects , Neomycin/immunology , Ontario , Patch Tests , Retrospective StudiesABSTRACT
BACKGROUND: Bacitracin is a commonly used topical antibiotic that has on occasion been reported to cause anaphylaxis. Evidence of the role of bacitracin specific IgE in such reactions has been demonstrated by skin testing. Because of the potential for provoking a systemic reaction by skin testing, it would be advantageous to develop an in vitro test for bacitracin specific IgE. OBJECTIVE: To report our experience coupling bacitracin to a solid phase and using it to detect specific IgE to bacitracin by fluorescent enzyme immunoassay. METHODS: A patient with a history of recurrent anaphylaxis that developed after application of triple antibiotic ointment to an open wound underwent skin testing with triple antibiotic ointment. Bacitracin was biotinylated and coupled to streptavidin ImmunoCAPs. IgE against bacitracin in the patient's serum was detected by fluorescent enzyme immunoassay. RESULTS: Topical application of triple antibiotic ointment to intact skin produced a 7 X 8-mm wheal with pseudopods. IgE against bacitracin was detected using biotinylated bacitracin-streptavidin ImmunoCAPs at a level of approximately 0.6 KUA/L and confirmed with ImmunoCAPs using direct coupling of bacitracin to the solid phase. CONCLUSIONS: We demonstrate the presence of IgE antibodies to bacitracin in a patient with anaphylaxis to triple antibiotic ointment using a recently described procedure for producing custom allergen solid phases for immunoassay.
Subject(s)
Anaphylaxis/diagnosis , Anti-Infective Agents, Local/adverse effects , Bacitracin/adverse effects , Drug Hypersensitivity/diagnosis , Immunoassay/methods , Immunoglobulin E/blood , Anaphylaxis/blood , Anaphylaxis/chemically induced , Anti-Infective Agents, Local/immunology , Bacitracin/immunology , Biotinylation , Drug Combinations , Drug Hypersensitivity/blood , Drug Hypersensitivity/immunology , Humans , Male , Middle Aged , Neomycin/adverse effects , Polymyxin B/adverse effects , Reproducibility of Results , Sensitivity and Specificity , Skin Tests , StreptavidinSubject(s)
Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/immunology , Dermatitis, Allergic Contact/immunology , Dermatologic Surgical Procedures , Petrolatum/therapeutic use , Postoperative Care , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents, Local/immunology , Bacitracin/immunology , Dermatitis, Allergic Contact/pathology , Humans , OintmentsSubject(s)
Anaphylaxis/chemically induced , Anti-Infective Agents, Local/adverse effects , Anti-Infective Agents, Local/immunology , Arthroplasty, Replacement, Knee/adverse effects , Bacitracin/adverse effects , Bacitracin/immunology , Intraoperative Complications/chemically induced , Therapeutic Irrigation/adverse effects , Anti-Infective Agents, Local/administration & dosage , Arthroplasty, Replacement, Knee/methods , Bacitracin/administration & dosage , Female , Humans , Immunoglobulin E/immunology , Knee Joint/surgery , Middle Aged , Reoperation , Skin TestsSubject(s)
Anaphylaxis/etiology , Anti-Infective Agents, Local/adverse effects , Bacitracin/adverse effects , Drug Hypersensitivity/etiology , Administration, Topical , Anaphylaxis/immunology , Animals , Anti-Infective Agents, Local/administration & dosage , Anti-Infective Agents, Local/immunology , Bacitracin/administration & dosage , Bacitracin/immunology , Drug Hypersensitivity/immunology , Humans , Immunologic Tests , Macaca mulatta , Male , Middle Aged , OintmentsSubject(s)
Anaphylaxis/etiology , Anti-Infective Agents, Local/immunology , Bacitracin/immunology , Tattooing/adverse effects , Adult , Anaphylaxis/diagnosis , Anti-Infective Agents, Local/adverse effects , Anti-Infective Agents, Local/therapeutic use , Bacitracin/adverse effects , Bacitracin/therapeutic use , Humans , Male , Skin Diseases, Bacterial/drug therapy , Skin Diseases, Bacterial/prevention & control , Skin TestsABSTRACT
Traditionally, bioassay has been the chosen technique for the determination of bacitracin compounds in animal feedingstuffs. However, detection and determination of this antibiotic have given problems when it is present at low levels. A competitive enzyme-linked immunosorbent assay (ELISA) by which it is possible to detect both bacitracin and zinc bacitracin at levels as low as 1 mg kg-1 in animal feeds is described. The ELISA technique has been used in this laboratory to monitor samples from a drug stability storage trial for the presence of zinc bacitracin. In addition, individual polypeptide components of zinc bacitracin have been separated by high-performance liquid chromatography. Fractions were collected and tested by the ELISA technique to assess the response between individual components and the primary antibody. The response was compared with known microbiological activity.