We studied the role of immediate and delayed type hypersensitivity (DTH) in beta lactam-induced hypersensitivity by performing a leucocyte migration inhibition test (LMIT), which proves the development of DTH, and by measuring serum antibodies by enzyme linked immunosorbent assay (ELISA).
1. An LMIT was performed in 89 patients with suspected beta lactam antibiotic allergy 50 with drug rash, 29 with drug fever, 24 with hepatopathy, 12 with eosinophilia and 2 with anaphylaxis, some patients having two or more concomitant symptoms). The LMIT was positive at a high rate of 74 %(66 cases).
2. In contrast, ELISA was positive in only 8%(7 cases), with IgG in 2 and IgM in 5 cases.
3. The LMIT results showed high correlation for the 35 drugs tested, except for latamoxef, which was positive in only one of four cases. In contrast, the ELISA was positive at a high rate for ceftizoxime (3/5 cases) and cephalexin (2/4 cases).
4. The LMIT was positive in 56-100 % in patients with symptoms other than urticaria, while ELISA was positive in only 0-20 % of the symptoms.
5. The seven patients who showed a positive response in the ELISA were also positive in the LMIT, suggesting that cellular and humoral immunity play a role in some patients with beta-lactam antibiotic allergy.
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