Streptomycin


Streptomycin is a chemical complex substance, being composed of a central hexose (streptidine) linked to an amine-substituted disaccharide. Widely used in the past (tuberculosis), its use has declined drastically but is now routinely added to cell culture media (PHA-LAK) and to Ham’s F-10 medium, which is used for in vitro fertilization.
 
Incidence
High in the past (> 2% of treatments).
 
Clinical manifestations
General: anaphylactic shock, fever, serum sickness.
 
Cutaneous: urticaria, rash, contact dermatitis, exfoliative dermatitis.
 
Haematological: eosinophilia, haemolytic anemia.
 
Diagnostic methods
Cutaneous testing.
 
Skin prick-tests (1 to 10 mg/ ml).
 
Intradermal skin-tests (1 mg/ ml).
 
Patch-tests with streptomycin in 2% pet. positive in patients with contact dermatitis.
 
Specific IgE (RAST, ELISA) few cases with positive results
 
Histamine-release test: one case with dose-dependent release following stimulation with streptomycin (1 ; 0.1 ; 0.01 µg/ml).
 
Drug re-challenge.
 
Mechanisms
High molecular mass impurities (streptomycin polymers) related to some reactions aminogroups of streptomycin are the allergens involved in immediate-type allergies.
 
Management
Desensitization (3 hours) beginning with 1 mg intravenously.

References

  1. Perez R, Garces M, Marcos M, Alonso L, Carretero P, Juste S, Blanco J, Navarro J, "Anaphylaxis induced by streptomycin in cell media", Allergy, 1996 ; 51 (2): 135-6
  2. Gauchia R, Rodriguez-Serna M, Silvestre J.F, Linana J.J, Ahaga A, "Allergic contact dermatitis from streptomycin in a cattle breed", Contact. Dermatitis, 1996 ; 35 (6): 374-5
  3. Abeck D, Kuwert C, Segnini-Torres M, Przybilla B, Ring J, "Streptomycin-induced anaphylactic reaction during in vitro fertilization (IVF)", Allergy., 1994 ; 49 (5): 388-9
  4. Tinkelman D.G, Bock S.A, "Anaphylaxis presumed to be caused by beef containing streptomycin", Ann. Allergy., 1984 ; 53 (3): 243-4

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