Whitaker, P., Gibson, A., Farrell, J. et al. (4 more authors) (2025) Prospective piperacillin lymphocyte transformation testing in patients with cystic fibrosis receiving regular and desensitization courses of piperacillin-tazobactam. The Journal of Allergy and Clinical Immunology: In Practice, 13 (3). pp. 594-609. ISSN 2213-2198
Abstract
Background
Piperacillin-tazobactam is used in patients with cystic fibrosis to treat recurrent respiratory infections. Exposure is associated with a high frequency of non-immediate hypersensitivity.
Objective
To assess the applicability of the lymphocyte transformation test (LTT) for the diagnosis of piperacillin hypersensitivity and the influence of desensitization on piperacillin-specific T-cell responses.
Methods
Study-arm one was an analysis of LTT responses from 58 naïve/baseline tolerant patients with samples collected over a three-year interventional phase. In study-arm two, seventeen hypersensitive patients were recruited and LTTs were conducted before and post-desensitization. Clinical hypersensitivity reactions in both arms were monitored over an eight-year observational period.
Results
Fifty-eight patients in study arm one received 611 (range, 2-40; mean±SD, 10.5±8.1) piperacillin-tazobactam courses during the interventional phase, of which 11 developed hypersensitivity. The patients that remained tolerant received 236 piperacillin-tazobactam courses in the observational period, of which 9 developed hypersensitivity. Ten/eleven interventional phase hypersensitive patients had a positive LTT, while one remained negative. 136 negative LTTs were recorded with 39 tolerant patients, while eight patients recorded a positive LTT, with 4 developing hypersensitivity during the observational period. Ten LTT positive patients in study arm two underwent piperacillin-tazobactam desensitization, with seven tolerating the drug. The strength of the LTT decreased during desensitization and negative results were recorded for a minimum of 14-days. During follow-up, eight patients tolerated 62 piperacillin-tazobactam courses through desensitization.
Conclusions
LTT is a sensitive marker of drug sensitisation that could be used to inform future patient management. Desensitization is associated with attenuation of the piperacillin-specific T-cell response.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2024 The Authors. This is an open access article under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | Human; T-cells; drug hypersensitivity; desensitization |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Medical Research (LIMR) > Division of Molecular Medicine |
Depositing User: | Symplectic Publications |
Date Deposited: | 17 Dec 2024 15:34 |
Last Modified: | 24 Mar 2025 16:20 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.jaip.2024.12.003 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:220903 |