L C Savic1, T Garcez2, P M Hopkins3, N J N Harper4, S Savic5. 1. Anaesthetic Department, St James's University Hospital, Leeds, UK. 2. Department of Immunology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. 3. Anaesthetic Department, St James's University Hospital, Leeds, UK Institute of Biomedical & Clinical Sciences, School of Medicine, University of Leeds. 4. Department of Anaesthesia, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK s.savic@leeds.ac.uk nigel.harper@cmft.nhs.uk. 5. Department of Clinical Immunology and Allergy, St James's University Hospital, Leeds, UK s.savic@leeds.ac.uk nigel.harper@cmft.nhs.uk.
Abstract
BACKGROUND: Anaphylaxis to teicoplanin appears to be extremely rare, with only one confirmed case report worldwide. Two anaesthetic allergy clinics in the UK have received a number of suspected cases referred for investigation, and we present here the first case series of teicoplanin allergy. METHODS: We investigated 20 cases of suspected teicoplanin allergy, identified from the two clinics over a period of two years. We devised a set of five criteria to categorize the certainty of their diagnosis. These included: (1) reaction within 15 min of administration of teicoplanin, (2) ≥2 features of anaphylaxis present, (3) positive skin testing or challenge testing, (4) raised serum mast cell tryptase (MCT), (5) alternative diagnosis excluded. Based on these criteria we defined the likelihood of IgE-mediated allergy to teicoplanin as: definite-met all criteria; probable-met criteria 1.2 and 5, plus 3 or 4; uncertain-met criteria 1.2 and 5; excluded- any others. RESULTS: We identified 7 'definite', 7 'probable' and 2 'uncertain' cases of teicoplanin allergy. Four cases were excluded. CONCLUSIONS: IgE-mediated anaphylaxis to teicoplanin appears to be more common than previously thought. This is true even if only definitive cases are considered. Investigation of teicoplanin allergy is hampered by the lack of standardized skin test concentrations. In some cases, there was a severe clinical reaction, but without any skin test evidence of histamine release. The mechanism of reaction in these cases is not known and requires further study.
BACKGROUND: Anaphylaxis to teicoplanin appears to be extremely rare, with only one confirmed case report worldwide. Two anaesthetic allergy clinics in the UK have received a number of suspected cases referred for investigation, and we present here the first case series of teicoplanin allergy. METHODS: We investigated 20 cases of suspected teicoplanin allergy, identified from the two clinics over a period of two years. We devised a set of five criteria to categorize the certainty of their diagnosis. These included: (1) reaction within 15 min of administration of teicoplanin, (2) ≥2 features of anaphylaxis present, (3) positive skin testing or challenge testing, (4) raised serum mast cell tryptase (MCT), (5) alternative diagnosis excluded. Based on these criteria we defined the likelihood of IgE-mediated allergy to teicoplanin as: definite-met all criteria; probable-met criteria 1.2 and 5, plus 3 or 4; uncertain-met criteria 1.2 and 5; excluded- any others. RESULTS: We identified 7 'definite', 7 'probable' and 2 'uncertain' cases of teicoplanin allergy. Four cases were excluded. CONCLUSIONS: IgE-mediated anaphylaxis to teicoplanin appears to be more common than previously thought. This is true even if only definitive cases are considered. Investigation of teicoplanin allergy is hampered by the lack of standardized skin test concentrations. In some cases, there was a severe clinical reaction, but without any skin test evidence of histamine release. The mechanism of reaction in these cases is not known and requires further study.
Authors: Paul James Antony Sice; Sarah Ford; Andrew Francis Whyte; James Robertson Greig Journal: Br J Clin Pharmacol Date: 2018-11-12 Impact factor: 4.335
Authors: Sameer Dhingra; Nor Azlina A Rahman; Ed Peile; Motiur Rahman; Massimo Sartelli; Mohamed Azmi Hassali; Tariqul Islam; Salequl Islam; Mainul Haque Journal: Front Public Health Date: 2020-11-04
Authors: Dirceu Solé; Maria Anita Costa Spindola; Marcelo Vivolo Aun; Liana Maria Tôrres de Araújo Azi; Luiz Antonio Guerra Bernd; Daniela Bianchi Garcia; Albertina Varandas Capelo; Débora de Oliveira Cumino; Alex Eustáquio Lacerda; Luciana Cavalcanti Lima; Edelton Flávio Morato; Rogean Rodrigues Nunes; Norma de Paula Motta Rubini; Jane da Silva; Maria Angela Tardelli; Alexandra Sayuri Watanabe; Erick Freitas Curi; Flavio Sano Journal: Braz J Anesthesiol Date: 2020-11-09