Dermatitis caused by penicillin in bulked milk supplies

Simulation of human exposure to benzylpenicillin residues via pork originating from pigs fed with a dairy by-product

The use of food industry by-products for feeding is restricted by European Union by-product regulation (1774/2002). However, the actual public health risks involved in the use of such products are poorly recognized. This study focuses on bovine milk rejected at the dairy because of a positive result in antimicrobial drug testing and thereafter used as feed for finisher pigs in Finland. In theory, this current practice could expose pork consumers to antimicrobial drug residues. Raw bulk milk samples originating from rejected lots were analysed with a multiresidue method detecting five beta-lactams, including benzylpenicillin. Based on the probabilistic simulation model developed, concentrations of benzylpenicillin in pork invariably remained below 1% of the maximum residue limit. Therefore, the use of this by-product as feed with the current practice was considered to pose only a negligible risk to consumers of pork products.

The development of an enzyme-linked immunosorbent assay (ELISA) for cephalexin

Cephalexin was structurally modified by the attachment of a spacer at the carboxylic acid through which it was subsequently covalently attached to BSA. This method permitted the molecule to be attached without cleavage of the beta-lactam ring giving a conjugate distinct from previously described immunogenic preparations of penicillins and cephalosporins. This approach required the development of a novel spacer molecule, and its synthesis and characterisation are reported. Rabbits were used to raise antisera and the antibodies produced were characterised with respect to their reactivity with cephalexin and various analogues, other cephalosporins, and a number of penicillins.

Risk assessment of antibiotic residues of beta-lactams and macrolides in food products with regard to their immuno-allergic potential

In human medicine drug allergy is a well-established side-effect of the therapeutic use of antibiotics, especially the beta-lactams. Side-effects caused by macrolides are uncommon and only a very few of these seem to be caused by allergic mechanisms. Clinically, drug allergy is characterized by a spectrum of reactions ranging from mild skin rashes to angio-oedema or life-threatening anaphylaxis. Concern has been expressed that antibiotic residues in meat and other foods might be responsible for similar hypersensitivity reactions in a small number of individuals. This review assesses the potential risk of such reactions in general, but focuses on allergy to penicillin and macrolide residues in particular. In relation to the risk of primary sensitization, it is unlikely that residues could contribute to the overall immune response in view of the very low levels that are likely to be encountered in comparison with the high levels received during therapeutic use. No evidence has been found that any individual has become sensitized by residues of either penicillins or macrolides. Furthermore, the oral route is much less sensitizing than parenteral administration and immunochemical studies with penicillin indicate that hapten-protein complexes formed in vivo are unlikely to be immunogenic because of their low dose, low epitope density and binding to autologous carrier proteins. For performed allergens, the epitope density was also too low to be immunogenic. Because of the ubiquitous nature of penicillin-producing moulds in nature and the extensive use of beta-lactam antibiotics in human medicine, it is unlikely that epidemiological studies could be undertaken that could allow quantification of the minimal risk. The risk of allergic reactions in pre-sensitized individuals can be assessed similarly and again it is concluded that factors such as dose, oral administration and low epitope density make it unlikely that a significantly antigenic derivative could be formed. However, a review of the literature on penicillin hypersensitivity revealed a very small number of previously sensitized individuals from whom there is reasonable clinical and documentary evidence that penicillin residues in milk triggered an allergic reaction, usually a rash. Although these cases are very rare (less than 10 cases reported in the last 25 years), they illustrate the continuing need to control antibiotic residues vigilantly. Animal models have not proved useful for predicting the risk of hypersensitivity reactions to drugs, since allergy in man is determined by genetic and other factors and no validated methods exist to determine a no-effect level.(ABSTRACT TRUNCATED AT 400 WORDS)

Drug and chemical residues in livestock

The problem of drug and chemical residues in foods of animal origin has become increasingly important to the entire livestock industry as growing consumer health concerns continue to erode the demand for these products. Although nearly 90 per cent of all drugs approved for use in livestock are available for over-the-counter sales, in the public's view, it is only the veterinarian who administers drugs to animals and who, therefore, is responsible for all drug residues in food. Congress has responded to these consumer concerns by applying increased pressure on the FDA to restrict the extra-label use of drugs by veterinarians. The veterinary profession now finds itself in a position in which it must reexamine its current drug-use policies and strive to develop policies that are more responsible to the consumer, both in appearance and substance.

Acute and chronic desensitization of penicillin-allergic patients using oral penicillin

The efficacy, safety and mechanisms of penicillin desensitization were studied in 24 adults and two children with serious infections that required therapy with a beta-lactam drug. Indications for desensitization included debilitating as well as life-endangering infections. Increasing oral doses of phenoxymethyl penicillin were administered at 15-minute intervals to a cumulative dose of 1.3 million units. Parenteral therapy with the beta-lactam drug of choice was instituted at that point. Immunologic complications of desensitization or therapy, ranging from pruritus to serum sickness, occurred in 12 patients. The appearance of gradually worsening wheezing led to abandonment of the procedure in one subject with cystic fibrosis and severe pulmonary disease. The remaining 25 patients were successfully desensitized and received full-dose parenteral therapy. Chronic desensitization was maintained in seven individuals with twice daily oral penicillins for 3 weeks to more than 2 years. No allergic complications of chronic desensitization or recurrent full-dose parenteral therapy were detected. Skin test reactions to one or all penicillin determinants became negative in 11 of 15 patients retested after acute desensitization. Two desensitized patients became skin test negative, remained skin test negative after cessation of desensitization, and tolerated subsequent beta-lactam therapy without allergic reactions or resensitization. The results of this study provide new evidence that acute and chronic penicillin desensitization is useful and an acceptably safe approach and suggest that antigen-specific mast cell desensitization contributes to the protection against anaphylaxis.