Occupational Asthma Reference

Coutts II, Dally MB, Newman Taylor AJ, Pickering CAC, Horsfield N, Asthma in workers manufacturing cephalosporins, Br Med J, 1981;283:950-95*,

Keywords: oa, as , pharmaceutical, cephalosporin, ch

Known Authors

Tony Pickering, Wythenshawe Hospital, Manchester, UK Tony Pickering

Tony Newman Taylor, Royal Brompton Hospital, London Tony Newman Taylor

Ian Coutts, Brompton Hospital and Cornwall Ian Coutts

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Abstract

We report two cases of asthma caused by exposure to cephalosporins.

CASE 1
A 35-year-old production research chemist had for two years had a dry
irritating cough which improved when away from work. He had also had
short-lived attacks of sneezing and chest tightness when weighing out small
quantities of 7-aminocephalosporanic acid (7ACA) and its tosyalate dihydrate
derivative (7CTD). He had no history of asthma, rhinitis, or eczema but
skin-prick tests were positive to cat, housedust, and house-dust mite extracts.
Bronchial provocation testing was carried out. The patient weighed
50 g amounts of 7ACA and 7CTD. This reproduced his symptoms and provoked
immediate falls in forced expiratory volume in Is. No reactions
were provoked by challenge with cephalexin powder or a control challenge
with magnesium stearate. Skin-prick test results were positive to solutions
of 7ACA and 7CTD at dilutions of 1 g/l but negative to cephalexin at 10 g/l.

CASE 2
A 36-year-old production worker had been intermittently exposed to
cephalexin over 10 years before starting work on a process in which
cephalexin monohydrate powder was dried. An airline hood was provided
for this work but he did not always wear it. After one month he developed
tightness in the chest and breathlessness, which resolved spontaneously
during a two-week absence from work but recurred shortly after his return
while donning overalls contaminated with cephalexin. These symptoms
also resolved spontaneously, but on returning to work 10 days later he had
an anaphylactic reaction and was admitted to hospital. He returned to
work only once, when he developed chest tightness after spending 20
minutes in the canteen. He had no history of asthma, rhinitis, or eczema but a skin-prick test result with grass pollen extract was positive.
Immediate asthmatic reaction resulting from five minutes exposure to dust created by weighing 50 g of 7ACA and 7CTD. Bronchial provocation testing was carried out. Cephalexin disolvate 1 mg diluted in 250 g of lactose was tipped between trays for 30 minutes. On the first occasion this provoked a 16% immediate fall in forced expiratory volume in Is; a 30% fall occurred when the test was repeated. Challenge with cephalexin monohydrate 2 mg in 250 g of lactose for five minutes provoked a 30% immediate fall in forced expiratory volume in Is. He did not react to control challenge with lactose. Skin-prick tests to cephalexin disolvate and monohydrate at a dilution of 0-1 mg/l elicited immediate reactions.
Atopic and non-atopic hospital staff unexposed to cephalosporins had
negative skin-prick test results to solutions used in the above cases.

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