Bacitracin


Antibiotic polypeptide complex produced by Bacillus subtilis widely used as topical antibacterial medication.
 
Incidence
Immediate allergy is infrequent (10 cases reported)
 
Contact dermatitis is common.
 
Risk factors
Compromised skin barrier (leg ulcers, excoriated dermatitis, burns).
 
Clinical manifestations
Usually severe: anaphylactic shock with hypotension (80%) pruritus, flush,
 
swelling of the tongue and face,
 
urticaria.
 
Contact dermatitis.
 
Diagnostic methods
Cutaneous testing
 
Skin prick-tests positive in a few cases of anaphylaxis (intradermal skin-tests may be dangerous).
 
Positive patch-tests in contact dermatitis.
 
Mechanisms
Strong evidence of IgE-mediated hypersensitivity including positive immediate skin tests, positive Prausnitz-Küstner tests, although IgE antibodies have not been disclosed by other methods.
 
Management
Avoidance.

References

  1. Lin F.L, Woodmansee D, Patterson R, "Near-fatal anaphylaxis to topical bacitracin ointment", J. Allergy. Clin. Immunol, 1998 ; 101 (1.1): 136-7
  2. Dyck E.D, Vadas P, "Anaphylaxis to topical bacitracin", Allergy., 1997 ; 52: 870-1
  3. Knowles S.R, Shear N.H, "Anaphylaxis from bacitracin and polymyxin B (polysporin) ointment", Int. J. Dermatol., 1995 ; 34 (8): 572-3
  4. Eedy D.J, Mc Millan J.C, Bingham E.A, "Anaphylactic reactions to topical antibiotic combinations", Postgrad. Med. J., 1990 ; 66 (780): 858-9
  5. Sprung J, Schedewie H.K, Campine J.P, "Intraoperative anaphylactic shock after bacitracin irrigation", Anesth. Analg., 1990 ; 71 (4): 430-3

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.