Prospective Piperacillin Lymphocyte Transformation Testing in Patients With Cystic Fibrosis Receiving Regular and Desensitization Courses of Piperacillin-Tazobactam.
Paul Whitaker, Andrew Gibson, John Farrell, Lindsey Gillgrass, Xiaoli Meng, Daniel Peckham, Dean John Naisbitt
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Abstract
Background: Piperacillin-tazobactam is used in patients with cystic fibrosis to treat recurrent respiratory infections. Exposure is associated with a high frequency of nonimmediate hypersensitivity.
Objective: To assess the applicability of the lymphocyte transformation test (LTT) for the diagnosis of piperacillin hypersensitivity and the influence of desensitization on piperacillin-specific T-cell responses.
Methods: Study arm 1 was an analysis of LTT responses from 58 naive/baseline tolerant patients with samples collected over a 3-year interventional phase. In study arm 2, 17 hypersensitive patients were recruited and LTTs were conducted before and after desensitization. Clinical hypersensitivity reactions in both arms were monitored over an 8-year observational period.
Results: In study arm 1, 58 patients received 611 piperacillin-tazobactam courses (range, 2-40; mean ± SD, 10.5 ± 8.1) during the interventional phase; 11 patients developed hypersensitivity. The patients who remained tolerant received 236 piperacillin-tazobactam courses in the observational period, 9 of whom developed hypersensitivity. Ten of 11 interventional phase hypersensitive patients had a positive LTT whereas one remained negative. We recorded 136 negative LTTs with 39 tolerant patients, whereas eight patients had a positive LTT and four developed hypersensitivity during the observational period. Ten LTT-positive patients in study arm 2 underwent piperacillin-tazobactam desensitization, with seven tolerating the drug. The strength of the LTT decreased during desensitization, and negative results were recorded for a minimum of 14 days. During follow-up, eight patients tolerated 62 piperacillin-tazobactam courses through desensitization.
Conclusions: The LTT is a sensitive marker of drug sensitization that could be used to inform future patient management. Desensitization is associated with attenuation of the piperacillin-specific T-cell response.
期刊介绍：
JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases.
This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders.
The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.
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