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668 Human seminal plasma (HSP) anaphylaxis
J ALLERGY CLIN IMMUNOL VOLUME 97, NUMBER 1, PART 3
665
666
C e f a z o l i n Specific Side C h a i n H y p e r s e n s i t i v i t y EA Weber. Bsc, MD. FRCP(C'J. Toronto. Ontario, C a - ~ In over I000 pts tested for penicillin allergy using benzylpenicillin (BPO), peniciUoyl-polylysine (PPL), minor determinant mix (MDM), ampicillin & cefazolin at lmg/ml, our overall skin test positivity is 4%. Our cefazolin skin test positivity is 0.9%. Of our 9 positive cefazolin skin tests, only one pt was positive exclusively to cefazolin. This pt was a 33 yr old female who developed severe anaphylaxis within 15 rain oflV administration of I &m of cefazolin preoperatively. She had no prior history of beta lactam allergy and had tolerated ampicillin in the past. Skin testing 4 mo later revealed an isolated positive intradermal (ID) skin test to cefazolin (1 mg/ml) with negative ID skin tests to BPO, PPL, MDM and ampicillin, cefotetan, ceitdaxone, cephalothin, cefuroxime and eefiazidime, all at lmg/ml. Oral challenges with full dose Penicillin VK, cefaclor, cefuroxime axetil & cephalexin were also negative confirming her tolerance to other beta lactams and supporting the hypothesis that this represented a side chain specific cefazolin allergy. Conclusions: A)side chain specific cefazolin allergy appears to be uncommon (0.1% or less) B)the incidence of false positive cefazolin skin tests is low C)a positive cefazolin skin test, especially in conjunction with a history of a reaction to cefazolin, is highly clinically significant D)an isolated positive eefazolin skin test warrants additional skin and oral/parenteral challenge testing to identify side chain specific allergy with good tolerance to other beta lactams.
A n a p h y l a x i s i n O l m s t e d C o u n t y . ]vfvV Y o c u m M D . M D Silverstein M D . JS Klein MD, Rochester, M N T h e epidemiology o f anaphylaxis o f all causes in a defined general population is u n k n o w n . In the current study, we identified all Olmsted C o u n t y residents with episodes of anaphylaxis from 1983-1987 in a retrospective population-based, cohort study. W e determined the cause of anaphylaxis, i n c i d e n c e of atopy, mortality rate, recurrence rate, and percent seen b y an allergist. A total of 1,080 charts were reviewed, a n d to date, 125 episodes o f anaphylaxis were identified o v e r 5 years in 110 patients. Episodes consisted o f m u c o - c u t a n e o u s s y m p t o m s plus either respiratory, cardiovascular, or gastrointestinal symptoms. A suspected allergen was identified in 7 3 % o f the episodes. S u s p e c t e d allergens were foods (39%), H y m e n o p t e r a (17%), m e d i c a t i o n s (14.5%), exercise (2.7%), and other (26%). Hospitalization occurred in 7.3% of patients, and 1 patient died o f anaphylaxis. The target organs i n v o l v e d in the anaphylactic episodes were cutaneous (86%), respiratory (79%), cardiovascular (41%), a n d gastrointestinal (25%). Allergy consultation was obtained in 52% o f patients, and 51% o f all patients w e r e atopic. Our conclusions are: (1) T h e cause o f an anaphylactic episode is frequently determined and h a l f o f patients are evaluated by an allergist. (2) Atopy is p r e s e n t in h a l f the patients experiencing anaphylaxis. (3) A n a p h y l a x i s is rarely fatal. (4) W e must strive to teach m o r e physicians to refer all anaphylaxis patients for allergy evaluation.
Abstracts
349
667
Long Term Follow-Up, Cost and Outlook. J Krasnick MD, R Patterson MD, KE Harris BS, Chicago, IL To determine the long term efficacy of a program of oral corticosteroids, antihistamines and sympathomimetics in treating patients with idiopathic anaphylaxis (IA). Sixty-one patients were available for evaluation from an original 225 patients seen with IA between 1971 and 1990. The number of emergency room visits, hospitalizations and intensive care unit admissions as well as the associated cost for care in the hospital was estimated. The number of patients that went into remission was also determined. Sixty-five percent of patients with infrequent episodes and 91% of patients with frequent episodes of IA went into remission. Significant decreased in emergency room visits occurred for the IAgeneralized frequent (p<.0001) and infrequent groups (p<.0001) groups, and for the IA-angioedema infrequent group (p<.039). A significant decrease in the number of hospitalizations (p<.022) and intensive care unit admissions (p<.009) occurred for IA-generalized infrequent and frequent groups, respectively. An estimated $184,740 was saved with the treatement programs for 546 patient years. IA can he controlled and a remission can he induced in most patients. We previously estimated that approximately 30,000 cases of IA exist in the United States. Based on this, an estimated $I 1 million per year can be saved for IA patients in the United States.
668
Human seminal plasma (HSP) anaphylaxis. DG Ebo
Idiopathic Anaphylaxis:
MD. WJ Stevens MD. CH Bridts MT. LS De Clerck MD. Antwerpen, Belgium. A 41-year-old woman was referred for evaluation of postcoital vaginal pruritis, urticaria and angioedema occurring within 5 minutes after ejaculation during intercourse. Ejaculation on the skin, resulted immediately in local itching, burning and whealing. Using condoms, the patient no longer experienced symptoms. The patient's history revealed rhinitis and conjunctivitis (house dust mite). Intercourse with two former partners never induced anaphylaxis. Total serum IgE was 180 KU/L. Specific IgE determination for common inhalant allergens were only positive for house dust mite: 14 KU/L and negative for latex and HSP. Skin prick tests were positive for house dust mite (wheal/flare 5/25 ram; histamine I mg/ml control 3/15). Skin prick tests with partner,s HSP at a 10"3 and 10"2 dilution resulted in a wheal/flare (mm) of respectively 8/20 and 12/30. Skin prick tests with HSP at a 10"i dilution produced a 15 mm wheal with pseudopods and 50 ram flare. Control injection of saline did not evoke wheal formation. Lymphocyte transformation index for PHA and PWM was normal. A stimulation index of 1.92 for HSP (1 mg/ml) was obtained (positive > 2). Anti-HSP lgEimmunodothlotting was negative. In conclusion, HSPA should always be considered in the differential diagnosis of anaphylaxis when there is an associated history of atopy. The diagnosis is established by determination of HSP-specific IgE or skin testing with whole sperm or seminal plasma.
665
666
C e f a z o l i n Specific Side C h a i n H y p e r s e n s i t i v i t y EA Weber. Bsc, MD. FRCP(C'J. Toronto. Ontario, C a - ~ In over I000 pts tested for penicillin allergy using benzylpenicillin (BPO), peniciUoyl-polylysine (PPL), minor determinant mix (MDM), ampicillin & cefazolin at lmg/ml, our overall skin test positivity is 4%. Our cefazolin skin test positivity is 0.9%. Of our 9 positive cefazolin skin tests, only one pt was positive exclusively to cefazolin. This pt was a 33 yr old female who developed severe anaphylaxis within 15 rain oflV administration of I &m of cefazolin preoperatively. She had no prior history of beta lactam allergy and had tolerated ampicillin in the past. Skin testing 4 mo later revealed an isolated positive intradermal (ID) skin test to cefazolin (1 mg/ml) with negative ID skin tests to BPO, PPL, MDM and ampicillin, cefotetan, ceitdaxone, cephalothin, cefuroxime and eefiazidime, all at lmg/ml. Oral challenges with full dose Penicillin VK, cefaclor, cefuroxime axetil & cephalexin were also negative confirming her tolerance to other beta lactams and supporting the hypothesis that this represented a side chain specific cefazolin allergy. Conclusions: A)side chain specific cefazolin allergy appears to be uncommon (0.1% or less) B)the incidence of false positive cefazolin skin tests is low C)a positive cefazolin skin test, especially in conjunction with a history of a reaction to cefazolin, is highly clinically significant D)an isolated positive eefazolin skin test warrants additional skin and oral/parenteral challenge testing to identify side chain specific allergy with good tolerance to other beta lactams.
A n a p h y l a x i s i n O l m s t e d C o u n t y . ]vfvV Y o c u m M D . M D Silverstein M D . JS Klein MD, Rochester, M N T h e epidemiology o f anaphylaxis o f all causes in a defined general population is u n k n o w n . In the current study, we identified all Olmsted C o u n t y residents with episodes of anaphylaxis from 1983-1987 in a retrospective population-based, cohort study. W e determined the cause of anaphylaxis, i n c i d e n c e of atopy, mortality rate, recurrence rate, and percent seen b y an allergist. A total of 1,080 charts were reviewed, a n d to date, 125 episodes o f anaphylaxis were identified o v e r 5 years in 110 patients. Episodes consisted o f m u c o - c u t a n e o u s s y m p t o m s plus either respiratory, cardiovascular, or gastrointestinal symptoms. A suspected allergen was identified in 7 3 % o f the episodes. S u s p e c t e d allergens were foods (39%), H y m e n o p t e r a (17%), m e d i c a t i o n s (14.5%), exercise (2.7%), and other (26%). Hospitalization occurred in 7.3% of patients, and 1 patient died o f anaphylaxis. The target organs i n v o l v e d in the anaphylactic episodes were cutaneous (86%), respiratory (79%), cardiovascular (41%), a n d gastrointestinal (25%). Allergy consultation was obtained in 52% o f patients, and 51% o f all patients w e r e atopic. Our conclusions are: (1) T h e cause o f an anaphylactic episode is frequently determined and h a l f o f patients are evaluated by an allergist. (2) Atopy is p r e s e n t in h a l f the patients experiencing anaphylaxis. (3) A n a p h y l a x i s is rarely fatal. (4) W e must strive to teach m o r e physicians to refer all anaphylaxis patients for allergy evaluation.
Abstracts
349
667
Long Term Follow-Up, Cost and Outlook. J Krasnick MD, R Patterson MD, KE Harris BS, Chicago, IL To determine the long term efficacy of a program of oral corticosteroids, antihistamines and sympathomimetics in treating patients with idiopathic anaphylaxis (IA). Sixty-one patients were available for evaluation from an original 225 patients seen with IA between 1971 and 1990. The number of emergency room visits, hospitalizations and intensive care unit admissions as well as the associated cost for care in the hospital was estimated. The number of patients that went into remission was also determined. Sixty-five percent of patients with infrequent episodes and 91% of patients with frequent episodes of IA went into remission. Significant decreased in emergency room visits occurred for the IAgeneralized frequent (p<.0001) and infrequent groups (p<.0001) groups, and for the IA-angioedema infrequent group (p<.039). A significant decrease in the number of hospitalizations (p<.022) and intensive care unit admissions (p<.009) occurred for IA-generalized infrequent and frequent groups, respectively. An estimated $184,740 was saved with the treatement programs for 546 patient years. IA can he controlled and a remission can he induced in most patients. We previously estimated that approximately 30,000 cases of IA exist in the United States. Based on this, an estimated $I 1 million per year can be saved for IA patients in the United States.
668
Human seminal plasma (HSP) anaphylaxis. DG Ebo
Idiopathic Anaphylaxis:
MD. WJ Stevens MD. CH Bridts MT. LS De Clerck MD. Antwerpen, Belgium. A 41-year-old woman was referred for evaluation of postcoital vaginal pruritis, urticaria and angioedema occurring within 5 minutes after ejaculation during intercourse. Ejaculation on the skin, resulted immediately in local itching, burning and whealing. Using condoms, the patient no longer experienced symptoms. The patient's history revealed rhinitis and conjunctivitis (house dust mite). Intercourse with two former partners never induced anaphylaxis. Total serum IgE was 180 KU/L. Specific IgE determination for common inhalant allergens were only positive for house dust mite: 14 KU/L and negative for latex and HSP. Skin prick tests were positive for house dust mite (wheal/flare 5/25 ram; histamine I mg/ml control 3/15). Skin prick tests with partner,s HSP at a 10"3 and 10"2 dilution resulted in a wheal/flare (mm) of respectively 8/20 and 12/30. Skin prick tests with HSP at a 10"i dilution produced a 15 mm wheal with pseudopods and 50 ram flare. Control injection of saline did not evoke wheal formation. Lymphocyte transformation index for PHA and PWM was normal. A stimulation index of 1.92 for HSP (1 mg/ml) was obtained (positive > 2). Anti-HSP lgEimmunodothlotting was negative. In conclusion, HSPA should always be considered in the differential diagnosis of anaphylaxis when there is an associated history of atopy. The diagnosis is established by determination of HSP-specific IgE or skin testing with whole sperm or seminal plasma.