Annual Meeting, Ottawa, October 21-24, 2004

11 Anaphylaxis after Topical Application of Bacitracin: A Case Report Mona Al-Ahmad, Sean Mace, University of Toronto, Toronto, ON Introduction: We present a case of anaphylaxis following repeated application of bacitracin. Method: A case report of a twenty-three year old woman with no prior allergic history who underwent body piercing of the navel. A low grade local infection developed at the site and this was treated intermittently over a period of weeks with topical bacitracin (Baciguent). Following one application she experienced rapid onset of pruritus of the head and hands, generalized urticaria, dyspnea, wheeze and dizziness. She was successfully treated in hospital for anaphylaxis and released. Results: Skin prick testing with bacitracin yielded a 25 millimetre wheal with pseudopods. Testing of bacitracin on a control subject was negative. Conclusion: Body-piercing is a common cosmetic procedure. Localized infection at the site of piercing is a common complication. Repeated application of a potentially sensitizing agent to an area of inflamed skin enhances the potential for the development of sensitization. Bacitracin is a topical antibiotic with the capability of inducing anaphylactic sensitivity following topical application. In a survey of body-piercing establishments in Toronto, 75% recommended the use of over-the-counter topical antibiotics such as Bactrim or bacitracin to treat localized infections after piercing. The use of bacitracin at sites of inflamed body piercings poses a risk for the development of anaphylactic sensitivity. A history of bacitracin use should be determined in patients with body piercings who develop anaphylaxis.