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Ciprofloxacin skin testing: A retrospective study
$168
97 mine Relationship Between Methods of Polymerization and HistaReleasability and Adjuvant Activity of Acrylic Resins Used in Dental Materials (DM) L. M. Du Buske I, A. A. Babakhin 2, A. I. Volozhin3, O. D. Vinogradova3, A. A. Vedernikov2; llmmunology Research Institute of New England, Fitchburg, MA, 2National Research Center-Institute of Immunology, Moscow, RUSSIAN FEDERATION, 3Moscow Medical and Dental University, Moscow, RUSSIAN FEDERATION. RATIONALE: Immune response to DM may be related to the method of acrylic polymerization. METHODS: Three samples of polymethyllactocrylate DM [Ftorax (F), Stomacryl (S) and Aetocryl (A)] were prepared by hot water polymerization, and by ultrasonic (U) polymerization, "FU," "SU," and "AU" respectively. All materials were pulverized and incubated in PIPES buffer at 37~ for 48 h, then were separated by centrifugation and supernatants (SNs) evaluated for leukocyte histamine release (HR). To assess adjuvant effects, (CBAxC57BI/6)FI mice were immunized with ovalbumin (10 ~g/mouse) with each pulverized DM (2.5 mg/mouse), with anti-OA IgE and IgG antibodies detected by passive cutaneous anaphylaxis and ELISA. RESULTS: SNs obtained from "A" demonstrated significant HR while SNs obtained from "AU" induced 4 fold less HR, comparable to control. SNs obtained from "F," "FU," "S" and "SU" had a low HR, comparable to control. DMs having ultrasonic polymerized showed less anti-OA IgE response compared to DMs obtained by thermopolymerization, but antiOA IgG antibody formation was similar CONCLUSIONS: Evaluation of histamine release and adjuvant effects of DMs may provide useful indices of the potential for immunologic effects induced by extractable DM ingredients.
Funding: National Research Center-Institute of Immunology
398
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
Abstracts
The
Utility of Skin Testing in SuspectedClindamycinAllergy
Health Sciences Center, Toronto, ON, CANADA, 3Division of Infectious Disease, Sunnybrook and Women's College Health Sciences Center, Toronto, ON, CANADA, 4Drug Safety Clinic, Sunnybrook and Women's College Health Sciences Center, Toronto, ON, CANADA, 5Division of Dermatology, Sunnybrook and Women's College Health Sciences Center, Toronto, ON, CANADA. RATIONALE: Limited information is available regarding the validity of procedures to diagnose allergic adverse drug reactions (ADRs) associated with fluoroquinolones (FQ). A retrospective study was undertaken to examine the clinical utility of ciprofloxacin (CP) skin testing. MATERIALS AND METHODS: A review of 135 charts from patients seen with suspected FQ associated ADRs between 1996-2001 was conducted at the Sunnybrook Drug Safety Clinic. Skin testing (prick and intradermal) was performed to CP (0.0001 mg/ml to 0.1 mg/ml) and levofloxacin (0.0001 mg/ml to 0.1 mg/ml) and oral challenge with CP (250 rag) and/or another FQ was administered tbllowing the negative skin tests. RESULTS: False positive reactions were associated with concentrations >0.05 mg/ml. 5/135 (4%) tested positive on the skin testing; 2 to levofloxacin and 3 to CP. 20/135 (15%) were positive on the oral challenge; however, only 9 (7%) subjects had reactions consisting of a rash and/or breathing difficulties within the time frame for an immediate or accelerated reaction (between 0 and 72 hours). The other 11 (8%) false negative reactions were potentially non-allergic (eg, pruritus, lightheadedness). There was a significant relationship between the original reaction history (indicative or non-indicative of immediate hypersensitivity) and positive oral challenge outcomes (true false negative or non-specific reactions) (P=0.0014, 95% CI). The negative predictive value for this test was determined to be 93.1%, which is comparable to the negative predictive value for penicillin, the gold standard for skin testing. CONCLUSIONS: Skin testing should be pursued as a diagnostic tool for suspected allergic ADRs associated with FQ antibiotics.
Funding: Self-funded S. R. Knowies, M. J. Notman, E. J. Phillips, E. A. Weber, N. H. Shear; Drug Safety Clinic, Sunnybrook & Women's College Health Sciences Centre, Toronto, ON, CANADA. RATIONALE: Skin testing has been validated for lgE-mediated reactions associated with penicillin but little information exists regarding this form of testing for other drugs. We explored the clinical utility of clindamycin prick testing and intradermal testing in patients with immediate or delayed reactions to clindamycin. METHODS: A total of 34 subjects with histories of reactions associated with clindamycin (14 accelerated reactions, 11 delayed, and 8 not documented) underwent prick and intradermal skin testing to clindamycin (0.15 mg/mt to 15 mg/mi) between 1999 and 2001. Subjects with negative skin testing received a single oral dose of clindamyein. RESULTS: Although none of the 34 prick and intradermal tests performed were positive, a significant number of patients [11/34 (32%)] had reactions to the oral challenge lie, immediate reactions (n=l) and accelerated reactions (n= 10)]. Sensitivity of the prick and intradermal testing was determined to be 0%, specificity 100%, positive predictive value 0%, and negative predictive value 68%. CONCLUSIONS: Our experience highlights the low clinical utility of prick and intradermal testing for allergic and cutaneous reactions associated with clindamycin. We caution against the use of clindamycin skin testing as a diagnostic tool in this setting. Although a single oral challenge appears to be highly predictive it should be used selectively given the potential for significant morbidity incurred by induced reactions.
Funding: Self-Junded
399 CiprofloxacinSkin Testing:A Retrospec,iveStudy M. J. Notman I, S. R. Knowles 2, E. J. Phillips 3, E. A. Weber4, N. H. ShearS; tDivision of Clinical Pharmacology, Sunnybrook and Women's College Health Sciences Center, University of Toronto, Toronto, ON, CANADA, 2Department of Pharmacy, Sunnybrook and Women's College
400
Diagnosisof Allergy to Quinolones
M. L. Somoza-Alvarez l, P. Casasnovas 2, A. Jim6nez-Blanco2, P. Poza 2, P. Rico 2, C. Lozoya-Ib~Sez2, G. Canto2; 1Allergy, Hospital Universitario Doce de Octubre, Madrid, SPAIN, 2H. U. Doce de Octubre, Madrid, SPAIN. BACKGROUND: Quinolones are a broad-spectrum antibiotics. They are divided into four generations depending on their chemical structure. They are very well-tolerated drugs. We have found few studies about crossreactivity between different generations and they do not include newest quinolones. MATERIAL AND METHODS: 4 patients referring adverse reactions to ciprofloxacin: general rash (patient 1), abdominal rash (patient 2), generalized urticaria (patient 3) and facial angioedema (patient 4). 5 controls were included. RESULTS: Prick test (PT) pipemidic negative in all patients. Oral challenge (OC) pipemidic positive in patient 4, negative in the others. PT ciprofloxacin 1/100, 1/10 negative in all patients and Itl positive in patient 1, negative in the others. ID test ciprofloxacin 1/100 negative in patient 3 and 4, positive in patient 1 and 2; 1/10 and I/I positive in all of them. OC ciprofloxacin positive in patient 2, 3 and 4. In patient 1 not done. PT levofloxacin negative in all patients. OC levofloxacin positive in patient 4, negative in the others. Controls: PT ciprofloxacin negative and ID positive in all of them. CONCLUSION: Skin tests value are controversial. PT results negative even after the positive OC. Although each time there was an intradermoreaction there was at the same time a positive OC, the controls had that intradermoreaction, too. We can conclude the only useful method in order to diagnosticate allergy to quinolones is the OC. We have observed crossreactivity between quinolones of different generations (1 patient out of 4) and that cross-reactivity happens also between last generation quinolones.
Funding: Self-funded
97 mine Relationship Between Methods of Polymerization and HistaReleasability and Adjuvant Activity of Acrylic Resins Used in Dental Materials (DM) L. M. Du Buske I, A. A. Babakhin 2, A. I. Volozhin3, O. D. Vinogradova3, A. A. Vedernikov2; llmmunology Research Institute of New England, Fitchburg, MA, 2National Research Center-Institute of Immunology, Moscow, RUSSIAN FEDERATION, 3Moscow Medical and Dental University, Moscow, RUSSIAN FEDERATION. RATIONALE: Immune response to DM may be related to the method of acrylic polymerization. METHODS: Three samples of polymethyllactocrylate DM [Ftorax (F), Stomacryl (S) and Aetocryl (A)] were prepared by hot water polymerization, and by ultrasonic (U) polymerization, "FU," "SU," and "AU" respectively. All materials were pulverized and incubated in PIPES buffer at 37~ for 48 h, then were separated by centrifugation and supernatants (SNs) evaluated for leukocyte histamine release (HR). To assess adjuvant effects, (CBAxC57BI/6)FI mice were immunized with ovalbumin (10 ~g/mouse) with each pulverized DM (2.5 mg/mouse), with anti-OA IgE and IgG antibodies detected by passive cutaneous anaphylaxis and ELISA. RESULTS: SNs obtained from "A" demonstrated significant HR while SNs obtained from "AU" induced 4 fold less HR, comparable to control. SNs obtained from "F," "FU," "S" and "SU" had a low HR, comparable to control. DMs having ultrasonic polymerized showed less anti-OA IgE response compared to DMs obtained by thermopolymerization, but antiOA IgG antibody formation was similar CONCLUSIONS: Evaluation of histamine release and adjuvant effects of DMs may provide useful indices of the potential for immunologic effects induced by extractable DM ingredients.
Funding: National Research Center-Institute of Immunology
398
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
Abstracts
The
Utility of Skin Testing in SuspectedClindamycinAllergy
Health Sciences Center, Toronto, ON, CANADA, 3Division of Infectious Disease, Sunnybrook and Women's College Health Sciences Center, Toronto, ON, CANADA, 4Drug Safety Clinic, Sunnybrook and Women's College Health Sciences Center, Toronto, ON, CANADA, 5Division of Dermatology, Sunnybrook and Women's College Health Sciences Center, Toronto, ON, CANADA. RATIONALE: Limited information is available regarding the validity of procedures to diagnose allergic adverse drug reactions (ADRs) associated with fluoroquinolones (FQ). A retrospective study was undertaken to examine the clinical utility of ciprofloxacin (CP) skin testing. MATERIALS AND METHODS: A review of 135 charts from patients seen with suspected FQ associated ADRs between 1996-2001 was conducted at the Sunnybrook Drug Safety Clinic. Skin testing (prick and intradermal) was performed to CP (0.0001 mg/ml to 0.1 mg/ml) and levofloxacin (0.0001 mg/ml to 0.1 mg/ml) and oral challenge with CP (250 rag) and/or another FQ was administered tbllowing the negative skin tests. RESULTS: False positive reactions were associated with concentrations >0.05 mg/ml. 5/135 (4%) tested positive on the skin testing; 2 to levofloxacin and 3 to CP. 20/135 (15%) were positive on the oral challenge; however, only 9 (7%) subjects had reactions consisting of a rash and/or breathing difficulties within the time frame for an immediate or accelerated reaction (between 0 and 72 hours). The other 11 (8%) false negative reactions were potentially non-allergic (eg, pruritus, lightheadedness). There was a significant relationship between the original reaction history (indicative or non-indicative of immediate hypersensitivity) and positive oral challenge outcomes (true false negative or non-specific reactions) (P=0.0014, 95% CI). The negative predictive value for this test was determined to be 93.1%, which is comparable to the negative predictive value for penicillin, the gold standard for skin testing. CONCLUSIONS: Skin testing should be pursued as a diagnostic tool for suspected allergic ADRs associated with FQ antibiotics.
Funding: Self-funded S. R. Knowies, M. J. Notman, E. J. Phillips, E. A. Weber, N. H. Shear; Drug Safety Clinic, Sunnybrook & Women's College Health Sciences Centre, Toronto, ON, CANADA. RATIONALE: Skin testing has been validated for lgE-mediated reactions associated with penicillin but little information exists regarding this form of testing for other drugs. We explored the clinical utility of clindamycin prick testing and intradermal testing in patients with immediate or delayed reactions to clindamycin. METHODS: A total of 34 subjects with histories of reactions associated with clindamycin (14 accelerated reactions, 11 delayed, and 8 not documented) underwent prick and intradermal skin testing to clindamycin (0.15 mg/mt to 15 mg/mi) between 1999 and 2001. Subjects with negative skin testing received a single oral dose of clindamyein. RESULTS: Although none of the 34 prick and intradermal tests performed were positive, a significant number of patients [11/34 (32%)] had reactions to the oral challenge lie, immediate reactions (n=l) and accelerated reactions (n= 10)]. Sensitivity of the prick and intradermal testing was determined to be 0%, specificity 100%, positive predictive value 0%, and negative predictive value 68%. CONCLUSIONS: Our experience highlights the low clinical utility of prick and intradermal testing for allergic and cutaneous reactions associated with clindamycin. We caution against the use of clindamycin skin testing as a diagnostic tool in this setting. Although a single oral challenge appears to be highly predictive it should be used selectively given the potential for significant morbidity incurred by induced reactions.
Funding: Self-Junded
399 CiprofloxacinSkin Testing:A Retrospec,iveStudy M. J. Notman I, S. R. Knowles 2, E. J. Phillips 3, E. A. Weber4, N. H. ShearS; tDivision of Clinical Pharmacology, Sunnybrook and Women's College Health Sciences Center, University of Toronto, Toronto, ON, CANADA, 2Department of Pharmacy, Sunnybrook and Women's College
400
Diagnosisof Allergy to Quinolones
M. L. Somoza-Alvarez l, P. Casasnovas 2, A. Jim6nez-Blanco2, P. Poza 2, P. Rico 2, C. Lozoya-Ib~Sez2, G. Canto2; 1Allergy, Hospital Universitario Doce de Octubre, Madrid, SPAIN, 2H. U. Doce de Octubre, Madrid, SPAIN. BACKGROUND: Quinolones are a broad-spectrum antibiotics. They are divided into four generations depending on their chemical structure. They are very well-tolerated drugs. We have found few studies about crossreactivity between different generations and they do not include newest quinolones. MATERIAL AND METHODS: 4 patients referring adverse reactions to ciprofloxacin: general rash (patient 1), abdominal rash (patient 2), generalized urticaria (patient 3) and facial angioedema (patient 4). 5 controls were included. RESULTS: Prick test (PT) pipemidic negative in all patients. Oral challenge (OC) pipemidic positive in patient 4, negative in the others. PT ciprofloxacin 1/100, 1/10 negative in all patients and Itl positive in patient 1, negative in the others. ID test ciprofloxacin 1/100 negative in patient 3 and 4, positive in patient 1 and 2; 1/10 and I/I positive in all of them. OC ciprofloxacin positive in patient 2, 3 and 4. In patient 1 not done. PT levofloxacin negative in all patients. OC levofloxacin positive in patient 4, negative in the others. Controls: PT ciprofloxacin negative and ID positive in all of them. CONCLUSION: Skin tests value are controversial. PT results negative even after the positive OC. Although each time there was an intradermoreaction there was at the same time a positive OC, the controls had that intradermoreaction, too. We can conclude the only useful method in order to diagnosticate allergy to quinolones is the OC. We have observed crossreactivity between quinolones of different generations (1 patient out of 4) and that cross-reactivity happens also between last generation quinolones.
Funding: Self-funded