J ALLERGY CLIN IMMUNOL

VOLUME 133, NUMBER 2

Abstracts AB273

ESDAY

941 Quinolones Allergy In An Allergy Unit. Our Experience In 3Years

Dr. Tamara Fernandez-Teruel1, Gabriela Zambrano, MD2, Celia Pinto1,

Beatriz Ameiro, MD2, Dr. Roberto Pelta1, Manuel De Barrio1; 1Depart-

ment of Allergy, Gregorio Mara~n�on University Hospital, Madrid, Spain,2Department of Allergy, Gregorio Mara~n�on University Hospital, Madrid,

Spain, Spain.

RATIONALE: Quinolones form a family of synthetic antibiotics. The aim

of this study was to determine the incidence, type of reaction, responsible

drug, diagnosis and crossreactivity to this drugs.

METHODS: A retrospective and descriptive study was performed in our

Allergy Service from January 2010 to December 2012. Clinical records,

data of skin tests and controlled challenge tests (CCT) were analyzed from

all patients with suspected hypersensitivity reactions to Quinolones.

RESULTS: We studied 115 adults patients with a suspected drug allergy

reactions to quinolones, confirming in 45(39.1%). Immediate 24(53%) and

non-immediate 21(47%); 71% female and 29% male. Exanthema ocurred

in 18(40.3%), Urticaria/Angioedema 15(33.3%), Anaphilaxis 7(15.5%),

FDE 3(6.6%), and cutaneous itch 2(4.4%). Ciprofloxacin was responsible

of the reaction in 42.2%, followed by Levofloxacin 33.3% and

Moxifloxacin 24.5%. Intradermal tests were positive in 2(4.4%)

(Levofloxacin), 29 negative. Patch test (PT) were positive in 5(11.1%)

with the implicated drug (2 for Ciprofloxacin, 3 for Moxifloxacin) and

negative in 9. CCT were positive in 7 (15.5%) (4 Ciprofloxacin, 2

Levofloxacin and 1 Moxifloxacin); were negative in 32. Due to patients

age, co-morbidity, negative tests and severity of reactions the diagnosis

was based on anamnesis in 69%.We studied crossreactivity in 27 patients,

of which 5(18.5%) have it (2 PT positives and 3 CCT positives).

CONCLUSIONS: Exantema are the most frequent reactions, and

Ciprofloxacin the main quinolones involved. The diagnosis was supported

by clinical history, positives skin tests and CCT. It’s important to study

cross-reactivity between quinolones in order to give therapeutics options to

the patients.

942 A Successful Desensitization Protocol For FilgrastimBrett Hronek, MD1, Anthony Kulczycki, Jr, MD, FAAAAI2;

1Washington University School of Medicine, St Louis, MO, 2Washington

University School of Medicine, St. Louis, MO.

RATIONALE: Filgrastim (Neupogen) is a granulocyte colony-stimu-

lating analog that stimulates the proliferation and differentiation of

granulocytes used clinically to prevent or treat neutropenia in patients

undergoing chemotherapy. This is the first report of a successful

desensitization to filgrastim of a patient with filgrastim hypersensitivity.

METHODS: This desensitization protocol was a modification of a

protocol published for molgramostim.

RESULTS: A 71 year-old man with multiple myeloma and treatment

associated myelodysplastic disorder was admitted to hospital for a bone

marrow transplant on a study protocol that required filgrastim treatment 21

days after the start of induction chemotherapy. Ten years earlier he first

received filgrastim and developed chest tightness that resolved without

treatment. Eightmonths ago he received his second course of filgrastim and

developed chest tightness, palpitations, dyspnea, and wheezing 2-3

minutes after administration. He was treated with methylprednisolone

and diphenhydramine intravenously with symptom resolution within one

hour. The patient had already started induction chemotherapy including

high-dose dexamethasone and anti-emetics, and therefore skin testing

could not be performed. A 15-step desensitization protocol was performed

successfully using sequential doses (mg) subcutaneously: 0.0012, 0.0024,

0.03, 0.06, 0.12, 0.3, 0.6, 1.2, 3, 6, 12, 30, 60, 120, and 255, to a final

cumulative dose of 488 mcg over approximately 5 hours. He successfully

received 480 mcg in one dose the following day.

CONCLUSIONS: We believe this is the first reported desensitization

protocol to filgrastim. This protocol may be used in patients with

hypersensitivity to filgrastim.

943 Are Proton Pump Inhibitors(PPI) Naive? A Case Of DrugReaction With Eosinophilia and Systemic Symptom (DRESS)Secondary To Lansoprazole

Dr. Aditya Uppalapati, MD1, Dr. Sindhura Gogineni, MD1,

Dr. Sravantika Koneru, MBBS2, Dr. Ghassan Kamel, MD3; 1St. Louis

University, St. Louis, MO, 2Mamata Medical College, 3Saint Louis

University, St. Louis.

RATIONALE: DRESS is a severe adverse drug induced reaction.

Mortality rate is up to 10%. PPI’S are widely used. DRESS syndrome

associated with PPI has been reported only in 1 case so far.We report a case

of DRESS due to lansoprazole.

METHODS: Case report.

RESULTS: A 40 years old Caucasian female patient with past medical

history of liver cirrhosis stage 3 secondary to alcohol was recently started

on lansoprazole. A month later she was admitted with complaints of

pruritis, generalized erythematous rash over the back and front of the chest,

maculopapular rash over the extremities and palmar erythema. Patient was

also noted to have acute kidney injury (AKI)-2.6 mg/dl, hyperbilirubine-

mia-22 mg/dl, acute respiratory failure requiring supplemental oxygen at

admission. WBC count was noted to be elevated-17, 000 cells/mm3 with

31% bandemia. A highest absolute eosinophil count of 4300/mm3 was

noted during the hospitalization. She was started on steroids, empiric

antibiotics. Liver biopsy showed fatty infiltration. Skin biopsy showed

perivascular inflammatory infiltrate with elevated eosinophils.

Autoimmune antibodies and hepatitis work up were negative. Human

herpes virus (HHV)-6 immunoglobulin G titer was elevated at

22.33(Positive >0.99). With worsening respiratory status and hypotension

patient was intubated and started on vasopressors. Initial Cultures were

negative but after about 2 weeks of hospital stay patient’s bronchoalveolar

lavage grew aspergillus. Inspite of starting on antifungals patient died from

multiorgan failure. Autopsy was also suggestive of DRESS as cause of

death.

CONCLUSIONS: PPI’s may not be naive. They can cause significant

hypersentivity reactions including DRESS.

944 Increased Of PCT and CRP In Dress Syndrome By Two DrugsStructurally Unrelated Molecular In The Same Pacient

Dr. Rafael A. Perez Arango; Ram�on and Cajal University Hospital,

Spain.

RATIONALE: DRESS syndrome is a life threatening adverse drug

reactionmost commonly associated with aromatic antiepileptic agents.We

present a young man with two episodes of DRESS caused by two drugs

structurally unrelated molecular with elevation of PCTand CRP at least on

one occasion.

METHODS: clinical evaluation and blood tests including serial mea-

surements of PCT and PCR performed to confirm the diagnosis.

RESULTS: 35 year old man black who in 2002 given prophylactic

phenytoin for seizures by cerebral tubercoloma. Threeweeks after fever up

to 398C, generalized pruritus, headache, nausea and vomiting. He

presented important bilateral palpebral angioedema and rash on lower

limbs. Analytical: Creatinine: 1.11 (previous 0.96), eosinophils: 4.500

GPT: 210 GOT: 74 GGT: 113. Offending drug is stopped and corticoste-

roids started presenting clinical and laboratory improvement within days.

In May 2013, during controlled oral challenge test for suspected hyper-

sensitivity to beta-lactams, received 500 mg of amoxicillin and after 3-4

hours presented generalized hives, malaise, asthenia, T: 39.18C and

hypotension maintained. Analytical: PCT: 61 PCR: 89 Eosinophils: 930.

Renal and hepatic function were normal. Infectious disease was excluded.

In both times, in a few days has intense skin desquamation and

improvement of analytical parameters.

CONCLUSIONS: we believe this is the first reported case of dress

syndrome caused by two drugs with different chemical structure and

effects debuting as infectious disease that causes elevation of inflammatory

markers of severity in at least once.

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