000065 - Does the teicoplanin skin test predict IgE-mediated hypersensitivity?

IgE-mediated hypersensitivity reactions to teicoplanin were considered rare untilrecently. However, case reports of IgE-mediated hypersensitivity to teicoplanin have been increasing  in recent years. These case reports also suggest that teicoplanin skin testing can predict IgE-mediated hypersensitivity reactions.

We present a case in which immediate hypersensitivity reaction developed during teicoplanin provocation, despite negative skin prick and intradermal tests with teicoplanin. A 66-year-old woman was consulted at our clinic with suspicion of a drug allergy. She had begun using teicoplanin and paracetamol 7 days prior after experiencing pus discharge from her knee following osteoarthritis surgery. Following this treatment, non-itchy rashes developed on her body. All medications were discontinued, and intravenous methylprednisolone was initiated. She was then consulted with us. On examination, mild erythematous plaques with a centripetal distribution occasionally extending to the extremities were present. The mucosa was normal, and there was no facial edema or peripheral lymphadenopathy. She had no known history of food, nutrition, or bee allergies. When the patient was consulted at our clinic, the observed symptoms were considered consistent with a drug allergy. It was recommended that the patient's teicoplaninin take be restrictedand a different agent be selected for antibiotic therapy. However, the infectious diseases department determined that the alternative treatment was not as effective as teicoplanin and that teicoplanin should be continued. During this time, the rash that developed in the patient's initial reaction completely resolved. Drug tests with teicoplanin were planned for the patient. The patient gave informed written consent before the procedure began.A skin prick test with teicoplanin at a concentration of 20 mg/ml and an intradermal test with 2 mg/ml were performed. Both tests were negative. Because the reaction that developed before the patient was referred to our clinic was consistent with an IgE-mediated early reaction, late reaction tests were not performed. The patient was initiated on drug challenge under observation in our clinic, and a 30-minute slow infusion of teicoplanin was initiated.Within 15 minutes of starting the infusion, urticaria developed on thepatient's back. Blood pressure was 120/75 mmHg, pulse rate was 80 bpm, and oxygen saturation was 96%. No uvular edema or angioedema was detected. The teicoplanin infusion was stopped immediately, and intramuscular pheniramine and 40 mg  intravenous methylpredisolone werea dministered. The urticaria resolved after one hour. Teicoplanin was discontinued, and the patient and the follow-up clinic were informed.

Our case shows that teicoplanin can cause IgE-mediated reactions and it highlights that skin prick test and intradermal test negativity are not sufficient to predict this condition.