title: [A clinical case of occupational allergy to piperacilline. A novel diagnostic method: basophil activation test (BAT)].
abstract: BACKGROUND
  Piperacillin, unlike other antibiotics, rarely causes immediate allergic reactions. Only two cases related to occupational exposure are reported in the literature.
  
  
  OBJECTIVE
  Adoption of new methods for diagnosis of occupational allergy to drugs.
  
  
  METHODS
  An atopic nurse, aged 30 years, was referred to our hospital for an allergic work-related reaction to piperacillin. The patient had suffered two successive episodes with immediate cutaneous reaction, angioedema and dyspnoea after preparing piperacillin. Almost four years previously she had suffered from similar symptoms after taking amoxicillin. She was submitted to a clinical examination and a routine allergic test, performing also specific IgE (Phadia Pharmacia ImmunoCap) and BAT (Basophil Activation Test) for Beta-lactam antibiotics.
  
  
  RESULTS
  A positive response to piperacillin was observed in our case using BAT a new non-invasive and safe method, that proved useful for diagnosis of allergy. Moreover, we observed a change from an allergic reaction for therapeutic use of amoxicillin to a work-related adverse reaction to another beta-lactam, piperacillin.
  
  
  CONCLUSIONS
  In previous clinical cases cutaneous and specific challenge tests were performed for diagnosis. At present, availability of an in vitro test, such as BAT may provide new diagnostic opportunities, and a useful tool for studying clinical cases other than, in perspective, monitoring exposed workers. Preventive measures were taken in the workplace to lower the risk of sensitization and allergic response. The nurse was transferred to a well controlled job.
authors.forename: P
authors.initials: P
authors.lastname: Marraccini
authors.forename: G
authors.initials: G
authors.lastname: Digiesi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pignatti
authors.forename: L
authors.initials: L
authors.lastname: Bordini
authors.forename: M
authors.initials: M
authors.lastname: Previdi
mesh_terms: D000328:Adult; D000799:Angioedema / Q000139:chemically induced / Q000175:diagnosis* / Q000276:immunology; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D015549:Basophil Degranulation Test; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D009726:Nurses; D009784:Occupational Diseases / Q000139:chemically induced / Q000175:diagnosis* / Q000276:immunology; D010878:Piperacillin / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012882:Skin Tests
chemical_list: D000900:Anti-Bacterial Agents; D007073:Immunoglobulin E; D010878:Piperacillin