[Occupation-related bronchial asthma caused by ampicillin. Diagnostic significance of occupation-specific inhalation provocation tests]

The case of a 58-year-old employee of an antibiotic-producing factory with occupationally related disorders (asthmatic dyspnea, episodic fever in the evening and malaise) is presented. A change of workplace did not completely relieve the patient. The further course was complicated by nephrolithiasis with urinary infection requiring nephroureterotomy. The extensive allergological investigation resulted in absolutely negative skin tests of the immediate and delayed type with environmental allergens including moulds and antibiotics. The serological examinations showed a high total IgE level and positive specific IgE to benzylpenicilloyl (BPO). The arterial blood gas analyses at rest showed that the patient hyperventilated massively. Consecutive inhalation of lactose, tetracycline, ampicillin and chloramphenicol dust administered by Spinhaler turboinhaler produced a delayed asthmatic reaction with an FEV1 a fall of 42% five hours after provocation, accompanied by general symptoms identified by the patient as here former disorders. Circulating immunocomplexes (C1q-binding test) were now positive, as was anti-BPO-IgG, while anti-BPO-IgE decreased slightly.