Occupational Rhinitis and Bronchospastic Reaction in a Worker Exposed to Imipenem

Hypersensitive reactions to drugs are poorly understood. Most are believed to be immunological, often expressions of Gel and Coombs Type I reactions mediated by IgE'. The immune mechanism and the immunochemistry of these reactions, especially to common offending agents, such as penicillin and other ,3-lactam antibiotics, have been extensively characterised 21. Hence skin testing procedures and standardisation of intradermal allergens for confirmation of a suspected IgE-mediated allergy to such agents have been validated and are in common use'-". Although adverse drug reactions are commonly observed in patients after the administration of antibiotics, occupational asthma due to penicillins has been described in healthcare and in pharmaceutical factory workers". Imipenem is a /3-lactam broad spectrum antibiotic, used in treatment for Gram positive and negative, aerobic and anaerobic bacteria'. Occupational exposure can also occur via inhalation in the manufacturing of the compound. The commercialised antibiotic is a 1:1 mixture of N formimidoyl-thienamicyn, a proximate principle, and cilistatin, an inhibitor of dehydropeptidase enzyme, which enhances urinary concentrations of an active drug. In this report we describe the case of a worker who presented with respiratory symptoms which were initially underestimated. The symptoms seemed to be related to the activity in the workplace (on-off test positive). Our goal was to establish the cause of such symptoms. The human study was conducted in accordance with the recommendations outlined in the Declaration of Helsinki. The authors obtained informed consent from the study subject.