Occupational allergy to β-lactam antibiotics

Background Contact urticaria in atopic patients was described by Hannuksela [1], among others, in 1980. It generally appears within 30 min of allergen contact and, in the majority of cases, is restricted to the areas of contact; however, local spread and generalized urticaria in the sense of anaphylaxis are seen. Allergic rhinoconjunctivitis and asthma may also subsequently occur [2]. Von Krogh and Maibach [3] subdivide contact urticaria into four degrees of severity: Grade I and II are restricted to the skin, i. e., localized urticaria (Stage I) and generalized urticaria (Stage II). Extracutaneous and systemic reactions (asthma, rhinitis, conjunctivitis, orolaryngeal symptoms, and gastrointestinal symptoms) are characterized as Grade III, and Grade IV refers to anaphylactic reactions. e prevalence of contact urticaria among healthcare workers is not known. It varies in Europe from 5 % to 10 %, whereas between 1 % and 3 % of the normal population in Russia is believed to be a ected [4]. In the case of regular contact, the prevalence of sensitization to drugs increases with working years (6.7 % a er 1 year vs. 47 % a er 7 years) [5]. e prevalence of occupational allergy to natural rubber latex in the 1990s was 8 %–17 % [6]. Contact urticaria can be triggered by a nonimmunological mechanism or an immunoglobulinE (IgE)-mediated immune response. In the former, vasoactive mediators are released, which cause mast cell degranulation without prior sensitization. e immunological form exhibits an allergic immediate-type reaction that is mediated by speci c IgE and which occurs in previously sensitized individuals. A dose dependence has been described for contact urticaria [7].