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Case Report |
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Diagnosis of Clavulanic Acid Allergy
Using Basophil Activation and Leukotriene Release by
Basophils |
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N Longo,1 PM Gamboa,2
G Gastaminza,1 MT Audícana,1
I Antepara,2 I Jaúregui, 2 ML Sanz3 |
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1 Allergy and Clinical Immunology
Department, Hospital Santiago Apóstol, Vitoria-Gasteiz,
Spain
2 Allergy Unit, Hospital de Basurto, Bilbao, Spain
3 Department of Allergy and Clinical Immunology,
University of Navarra, Pamplona, Spain |
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J Investig Allergol Clin Immunol
2008; Vol. 18(6): 473-475 |
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Abstract |
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Clavulanic acid is a
potent inhibitor of
ß-lactamase that is
increasingly
prescribed in
association with
amoxicillin. We
report 2 cases of
patients who
experienced pruritus,
wheals, and
angioedema after
oral intake of
amoxicillin/clavulanic
acid. Routine skin
tests for ß-lactam
antibiotics and
specific
immunoglobulin (Ig)
E were negative in
both patients.
Analysis of CD63
expression by the
basophil activation
test (BAT) using
flow cytometry and
of
sulphidoleukotriene
(sLT) release by
basophils using the
cellular allergen
stimulation test
(CAST) revealed
significant positive
responses with
amoxicillin/clavulanic
acid and with
clavulanic acid, and
negative responses
with amoxicillin and
other ß-lactam
antibiotics. In
addition, cultured
CD3+CD4+ cells
showed a significant
increase in the
expression of CD69,
CD25, and HLA-DR
in the presence of
clavulanic acid.
Both patients
tolerated
therapeutic doses of
amoxicillin. BAT and
CAST are useful ex
vivo procedures for
the detection of
specific IgE-mediated
allergy to
clavulanic acid,
especially for
patients with
negative skin test
results.
Key words:
Clavulanic acid. ß-lactam
antibiotics.
Basophil activation
test.
Sulphidoleukotrienes.
Lymphocyte
activation markers.
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