Selective hypersensitivity to boiled razor shell.

Many types of seafood require cooking before ingestion and it has been demonstrated that this cooking process may affect the antigenicity and allergenicity of the food. We describe a case of anaphylaxis caused by selective sensitization to razor shell, a mollusc. In vivo and in vitro studies confirmed sensitization to boiled razor shell. Analysis of the nature of the allergen yielded results that were consistent with the findings of other authors and suggested that allergens involved in seafood allergy are commonly high molecular weight proteins that, in most cases, are heat stable.

Allergy to cloxacillin with normal tolerance to amoxicillin and cefuroxime.

BACKGROUND: Cloxacillin is a semisynthetic penicillin widely used in nonmethicillin resistant Staphylococcus aureus infections. Several hypersensitivity reactions to cloxacillin have been reported, although IgE-mediated allergic reactions to the drug are rare and there is little information about possible tolerance to other semisynthetic penicillins or cephalosporins in patients with cloxacillin allergy. We present 2 patients with demonstrated IgE-mediated allergy to cloxacillin and tolerance to amoxicillin and cefuroxime. CASE REPORTS: Case 1. A 47-year-old woman began treatment with cloxacillin due to acute cellulitis. After ingesting 500 mg of the drug, she experience generalized maculopapular eruption and facial angioedema. Case 2. A 55-year-old woman presented an episode of acute urticaria and labial angioedema 60 minutes after ingesting 500 mg of cloxacillin for a skin abscess. METHODS AND RESULTS: Skin prick tests were positive to cloxacillin in case 1 and negative in case 2. However, an intradermal test was positive to cloxacillin (2 mg/ml) in case 2. Simple-blind oral challenge tests with amoxicillin (1 g) and cefuroxime (500 mg) were well-tolerated by both patients. CONCLUSIONS: We present 2 patients allergic to cloxacillin with normal tolerance to other betalactam antibiotics, confirming that cross-reactivity among these antibiotics seems to be uncommon. Complete allergy study, including an oral challenge test, should be considered in these patients.

Allergy to cloxacillin with normal tolerance to amoxicillin and cefuroxime / Alergia a cloxacilina con tolerancia normal a amoxicilina y cefuroxima

Background: Cloxacillin is a semisynthetic penicillin widely used in nonmethicillin resistant Staphylococcus aureus infections. Several hypersensitivity reactions to cloxacillin have been reported, although IgE-mediated allergic reactions to the drug are rare and there is little information about possible tolerance to other semisynthetic penicillins or cephalosporins in patients with cloxacillin allergy. We present 2 patients with demonstrated IgE-mediated allergy to cloxacillin and tolerance to amoxicillin and cefuroxime. Case reports: Case 1. A 47-year-old woman began treatment with cloxacillin due to acute cellulitis. After ingesting 500 mg of the drug, she experience generalized maculopapular eruption and facial angioedema. Case 2. A 55-year-old woman presented an episode of acute urticaria and labial angioedema 60 minutes after ingesting 500 mg of cloxacillin for a skin abscess. Methods and results: Skin prick tests were positive to cloxacillin in case 1 and negative in case 2. However, an intradermal test was positive to cloxacillin (2 mg/ml) in case 2. Simple-blind oral challenge tests with amoxicillin (1 g) and cefuroxime (500 mg) were well-tolerated by both patients. Conclusions: We present 2 patients allergic to cloxacillin with normal tolerance to other betalactam antibiotics, confirming that cross-reactivity among these antibiotics seems to be uncommon. Complete allergy study, including an oral challenge test, should be considered in these patients

Introducción: La cloxacilina es un penicilina semisintética ampliamente utilizada en las infecciones por Staphylococcus aureus no resistente a meticilina. Se han descrito diferentes reacciones de hipersensibilidad a cloxacilina, aunque las IgE mediadas son raras y hay poca información sobre el control de estos pacientes en cuanto a su posible tolerancia a otras penicilinas o cefalosporinas. Presentamos dos casos con alergia a cloxacilina, con lo que se demuestra un mecanismo IgE mediado con tolerancia a amoxicilina y cefuroxima. Casos clínicos: a) mujer de 47 años que comenzó un tratamiento con cloxacilina para tratar una celulitis aguda. Tras la toma de 500 mg, presentó una erupción maculopapular y angioedema facial, y b) mujer de 55 años que, 1 h después de la toma de 500 mg de cloxacilina por un absceso cutáneo, presentó un cuadro de urticaria y angioedema labial. Las pruebas cutáneas en Prick fueron positivas a cloxacilina en la primera paciente y negativas en la segunda, aunque en ésta la prueba intradérmica fue positiva (2mg/ml). Se realizaron provocaciones orales simple-ciego con amoxicilina (1 g) y cefuroxima (500 mg), bien toleradas en ambas pacientes. Conclusiones: Presentamos los casos de dos pacientes alérgicas a cloxacilina que toleran otros antibióticos betalactámicos, lo que confirma que un mecanismo de reactividad cruzada entre ellos parece ser infrecuente. Por ello, debe plantearse siempre un estudio alergológico que incluya la provocación oral en los pacientes alérgicos a cloxacilina

Anaphylaxis to oral furosemide.

Furosemide, one of the most used diuretic drugs, rarely induces type-1 allergic reactions It is included in the non-aromatic sulfonamides but a cross-reactivity mechanism between this group and the sulfonamides antibiotics, has not been clearly demonstrated. A 24-year-old woman, 10 minutes after the intake of one pill of Seguril 40mg experienced oral itching, generalized urticaria, facial angioedema, dyspnea and hypotension. She recovered after the administration of parental adrenaline, methyl-prednisolone and dyphenhydramine. An skin prick test with furosemide (10 mg/ml) was negative. The intradermal skin tests were positive to furosemide (1 %) as well as sulfamethoxazole (0.03 mg/ml), with 10 atopic and non-atopic negative controls. The patient rejected the performance of an oral challenge test with sulfamethoxazole. IgE-mediated reactions to furosemide are infrequent, but it could be the cause of life-threatening reactions. We have reported a case of anaphylaxis after the oral administration of furosemide with a demonstrated hypersensitivity mechanism through the positive intradermal skin test. The previous administration of the drug could probably the mechanism of sensitization, but the positive intradermal test to sulfamethoxazole would open the hypothesis of a cross-reactivity between non-aromatic and antimicrobial sulfonamides. It could be necessary an oral challenge test with furosemide in allergic patients to sulfamides.

Anaphylaxis to oral furosemide

Furosemide, one of the most used diuretic drugs, rarely induces type-1 allergic reactions It is included in the non-aromatic sulfonamides but a cross-reactivity mechanism between this group and the sulfonamides antibiotics, has not been clearly demonstrated. A 24-year-old woman, 10 minutes after the intake of one pill of Seguril 40mg® experienced oral itching, generalized urticaria, facial angioedema, dyspnea and hypotension. She recovered after the administration of parental adrenaline, methyl-prednisolone and dyphenhydramine. An skin prick test with furosemide (10 mg/ml) was negative. The intradermal skin tests were positive to furosemide (1 %) as well as sulfamethoxazole (0.03 mg/ml), with 10 atopic and non-atopic negative controls. The patient rejected the performance of an oral challenge test with sulfamethoxazole. IgE­mediated reactions to furosemide are infrequent, but it could be the cause of life-threatening reactions. We have reported a case of anaphylaxis after the oral administration of furosemide with a demonstrated hypersensitivity mechanism through the positive intradermal skin test. The previous administration of the drug could probably the mechanism of sensitization, but the positive intradermal test to sulfamethoxazole would open the hypothesis of a cross-reactivity between non-aromatic and antimicrobial sulfonamides. It could be necessary an oral challenge test with furosemide in allergic patients to sulfamides (AU)

La furosemida, uno de los fármacos diuréticos más usados, raramente induce reacciones de hipersensibilidad con un mecanismo de tipo 1, es decir mediado por IgE. Pertenece al grupo de las sulfonamidas no-aromáticas pero no se ha podido demostrar un mecanismo de reacción cruzada entre este grupo y el de las sulfamidas con función antibiótica. Presentamos el caso de una mujer de 24 años, sin antecedentes alérgicos de interés, que padecía de ovarios poliquísticos. Tras la toma de un comprimido oral de Seguril 40 mg, a los 10 minutos, comenzó con prurito cutáneo, formación de pápulas y máculas generalizadas, angioedema facial, disnea e hipotensión. Se recuperó tras la administración de adrenalina, metil-prednisolona y difenhidramina por vía parenteral. Se realizó una prueba cutánea en prick con furosemida (10 mg/mL) que fue negativa y una prueba cutánea en intradermorreacción que resultó positiva a furosemida (1 por ciento) y a sulfametoxazol (0.03 mg/mL), resultando negativas en 10 sujetos atópicos y no atópicos utilizados como controles. La paciente rechazó la realización de una prueba de provocación oral con sulfametoxazol. Las reacciones mediadas por IgE debidas al uso de furosemida son infrecuentes, pero no debemos olvidar que puede ocasionar situaciones de riesgo vital para el paciente. Comunicamos un caso de anafilaxia tras la toma de furosemida por vía oral en el que hemos demostrado un mecanismo de hipersensibilidad por pruebas cutáneas. La administración previa del fármaco es, probablemente, el medio de la sensibilización al mismo, pero la positividad de las pruebas intradérmicas al sulfametoxazol, abre la puerta a un mecanismo de reacción cruzada entre las sulfamidas no aromáticas y los antibióticos de dicho grupo, lo que obligaría a realizar una prueba de provocación oral con furosemida en pacientes alérgicos a sulfamidas (AU)