Detection of IgE antibodies to bacitracin using a commercially available streptavidin-linked solid phase in a patient with anaphylaxis to triple antibiotic ointment

• Published in: Annals of Allergy, Asthma & Immunology Vol. 98; no. 6; pp. 563 - 566
• Main Authors: Sharif, Saba, MD, Goldberg, Bruce, MD, PhD
• Format: Journal Article
• Language: English
• Published: McLean, VA Elsevier Inc 01-06-2007; American College of Allergy, Asthma, & Immunology
• Subjects: Allergy and Immunology; Anaphylaxis - blood; Anaphylaxis - chemically induced; Anaphylaxis - diagnosis; Anti-Infective Agents, Local - adverse effects; Anti-Infective Agents, Local - immunology; Bacitracin - adverse effects; Bacitracin - immunology; Biological and medical sciences; Biotinylation; Drug Combinations; Drug Hypersensitivity - blood; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - immunology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunoassay - methods; Immunoglobulin E - blood; Male; Medical sciences; Middle Aged; Neomycin - adverse effects; Polymyxin B - adverse effects; Reproducibility of Results; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sensitivity and Specificity; Skin Tests; Streptavidin; Human; Allergy; Immunopathology; Cyclic peptides; Antibody; Dermatology; IgE; Ointment; Bacitracin; Antibiotic; Anaphylaxis; Immunology; Polypeptide; Streptavidin; Diagnosis; Solid phase; Detection
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/S1081-1206(10)60736-3

Background Bacitracin is a commonly used topical antibiotic that has on occasion been reported to cause anaphylaxis. Evidence of the role of bacitracin specific IgE in such reactions has been demonstrated by skin testing. Because of the potential for provoking a systemic reaction by skin testing, it would be advantageous to develop an in vitro test for bacitracin specific IgE. Objective To report our experience coupling bacitracin to a solid phase and using it to detect specific IgE to bacitracin by fluorescent enzyme immunoassay. Methods A patient with a history of recurrent anaphylaxis that developed after application of triple antibiotic ointment to an open wound underwent skin testing with triple antibiotic ointment. Bacitracin was biotinylated and coupled to streptavidin ImmunoCAPs. IgE against bacitracin in the patient's serum was detected by fluorescent enzyme immunoassay. Results Topical application of triple antibiotic ointment to intact skin produced a 7 × 8-mm wheal with pseudopods. IgE against bacitracin was detected using biotinylated bacitracin-streptavidin ImmunoCAPs at a level of approximately 0.6 KUA /L and confirmed with ImmunoCAPs using direct coupling of bacitracin to the solid phase. Conclusions We demonstrate the presence of IgE antibodies to bacitracin in a patient with anaphylaxis to triple antibiotic ointment using a recently described procedure for producing custom allergen solid phases for immunoassay.