With regard to piperacillin, there is only one published statement of occupational asthma, rhinitis, and urticaria inside a pharmaceutical worker (1). diseases, including bronchial asthma (1, 2), anaphylaxis (3), contact urticaria (4), contact dermatitis (5), and hypersensitivity pneumonitis (6), in pharmaceutical workers and health care professionals. Most of these penicillins belong to the benzylpenicillin or aminopenicillin family. ITX3 Occupational contact urticaria and anaphylaxis induced by cephalosporins have often been reported (7). With regard to piperacillin, there is only one published report of occupational asthma, rhinitis, and urticaria in a pharmaceutical worker (1). However, to our knowledge, there has been no statement of occupational anaphylaxis induced by piperacillin. Furthermore, no evidence of a serum IgE antibody response to piperacillin has been published. This is thus the first statement of occupational anaphylaxis due to piperacillin and detection of a serum IgE response to a piperacillin-HSA conjugate. CASE DESCRIPTION The subject was a 24-yr-old female nurse who worked in the rigorous care unit at a University or college Hospital. She experienced dealt with piperacillin/tazobactam without gloves or a mask since ITX3 March 2003. Eighteen months later (October 2004), she experienced generalized urticaria with onset immediately and repeatedly after she experienced administered piperacillin. Nevertheless, she continued to work and finally experienced chest tightness, dizziness, sweating, generalized urticaria, abdominal pain, and diarrhea 10 min after giving a piperacillin injection in April 2005. Her blood pressure was 80/50 mmHg with a pulse rate of 104 beats/min. Her breath sounds were clear. The symptoms resolved completely after treatment with epinephrine, diphenhydramine, and methylprednisolone. She experienced a previous history of atopic dermatitis, and her hand eczema experienced become exacerbated after she experienced begun to work at the hospital. Skin prick assessments and measurement of serum total IgE Skin prick assessments using 80 common inhalant and food allergens (Bencard, Brentford, UK) were all unfavorable. We did not perform a skin prick test with piperacillin/tazobactam because of the ITX3 risk of anaphylaxis (8). Serum total IgE, measured using an immuno-CAP? system (Phadia, Uppsala, Sweden), was 283 IU/mL. Assay of serum IgE and IgG levels To assay piperacillin-specific serum IgE and IgG, we prepared piperacillin-human serum albumin (HSA) conjugates in our laboratory and performed an ELISA as explained previously (11). Piperacillin-specific IgE and IgG levels in an initial serum sample and the IgE level in a serum sample obtained 5 yr later (May 2010) were measured. In brief, ITX3 the wells of a 96-well ELISA microplate (Corning, New York, NY, USA) were coated by incubation with piperacillin-HSA conjugate at 10 g/mL in phosphate-buffered saline (PBS) immediately at 4. After the wells were washed four occasions with 350 L of PBS made up of 0.05% Tween 20 (PBS-T; Sigma-Aldrich, St. Louis, MO, USA), nonspecific binding sites were blocked by incubation with 200 L of 10% fetal bovine serum (FBS; GIBCO/Invitrogen, Carlsbad, CA, USA) in PBS at room heat for 2 hr. After washing four occasions with 0.05% PBS-T, 50 L of diluted serum (1:3) were added to each well, followed by incubation for 2 hr at 37. The plate was washed four occasions with 0.05% PBS-T, then 100 L of goat anti-human IgE antibody (Kirkegaard & Perry Laboratories, Inc., Gaithersburg, MD, USA) diluted 1:1,000 with 10% FBS-PBS were added to each well, and the plate was incubated for 1 hr at room temperature. After washing four occasions with 0.05% PBS-T, 100 L of alkaline phosphate-conjugated rabbit anti-goat IgG antibody (ReserveAPTM; Kirkegaard & Perry Laboratories) diluted 1:500 with 10% FBS-PBS were added to each well, ITX3 and the plate was incubated for 1 hr at room heat. PNPP (p-nitro-phenyl phosphate; Sigma-Aldrich) substrate was added, and the reaction was stopped by the addition Rabbit polyclonal to PI3Kp85 of 1 N NaOH. The optical density of the solution in each well was measured at 405 nm using.