D3.89 - Unexpected Culprit: The Role of Acrylates in Recurrent Anaphylaxis and Antibiotic Hypersensitivity
Case report
A 26-year-old female patient was admitted to our tertiary allergy centre due to a history of antibiotic hypersensitivity, with the aim of identifying a safe therapeutic alternative. In December 2022, the patient presented to her primary care physician with an upper respiratory tract infection and was prescribed oral clindamycin, which she had previously tolerated well. Approximately 20 minutes after the first dose, she developed dyspnea, throat and facial swelling, widespread urticaria, vertigo, palpitations, chest pain, and loss of consciousness, consistent with an anaphylactic reaction.
The patient's medical history revealed two prior, albeit less severe, anaphylactic episodes during childhood following oral administration of either amoxicillin-clavulanic acid or cefuroxime. Additionally, the patient reported symptoms suggestive of food allergy to various products, including nuts, fruit preserves, and certain vegetables, such as diarrhea, facial oedema and pruritus. These reactions were transient and inconsistent, and no clear cofactors—such as pollen season, NSAID use, or physical exertion—were identified.
As part of an extended allergy workup, patch testing was performed using the Polish Standard Series, which revealed a strong positive reaction to acrylate haptens. Further discussion with the patient indicated that a potential common factor linking the reported food-related allergic episodes and the clindamycin-induced anaphylaxis was her prior application of hybrid (gel) nail polish containing acrylates.
This case highlights the potential role of acrylate sensitization as a contributing factor in systemic hypersensitivity reactions and underscores the importance of considering environmental and occupational exposures in the differential diagnosis of complex allergy cases. Further research is warranted to elucidate the mechanisms linking cutaneous sensitization to systemic allergic phenomena, particularly in the context of antibiotic hypersensitivity.
