A Case of Chlorpheniramine Maleate-Induced Hypersensitivity With Aspirin Intolerance

Abstract

Antihistamines are commonly used to treat allergic disease, such as allergic rhinitis, urticaria, and angioedema. Although several previous reports describe hypersensitivity to antihistamines such as cetirizine and hydroxyzine, documented cases of chlorpheniramine hypersensitivity are extremely rare. Here, we report the case of a 45-year-old Korean woman who presented with urticaria after ingesting a cold medication. Over the previous 5 years, she had also experienced a food allergy to crab and shrimp, allergic rhinitis, and repeated urticaria after ingesting cold medication. Provocation with aspirin elicited generalized urticaria. Intravenous chlorpheniramine and methylprednisolone was injected for symptom control, but in fact appeared to aggravate urticaria. A second round of skin and provocation tests for chlorpheniramine and methylprednisolone showed positive results only for chlorpheniramine. She was diagnosed with aspirin intolerance and chlorpheniramine hypersensitivity, and was instructed to avoid these drugs. To date, this is the second of only two cases of chlorpheniramine-induced type I hypersensitivity with aspirin intolerance. Although the relationship between aspirin intolerance and chlorpheniramine-induced type I hypersensitivity is unclear, physicians should be aware of the possibility of urticaria or other allergic reactions in response to antihistamines.

Chlorpheniramine-induced anaphylaxis diagnosed by basophil activation test

“…They may not assess the causal relationships but only the sensitization, but have potentially wider clinical applications for their better safety. In the literature, several tests have been utilized for chlorpheniramine allergy [ 1 2 3 4 5 6 ]. Oral or intramuscular provocation tests were performed in four cases [ 1 2 5 ], whereas skin tests were used in three cases [ 3 4 6 ].…”

“…Chlorpheniramine is one of the most classical H1-antihistamines, primarily prescribed for histamine-mediated hypersensitivity reactions such as urticaria. In the literature, cases have been rarely reported for chlorpheniramine-induced immediate hypersensitivity reactions [ 1 2 ], even when including pheniramine [ 3 ] or dexchlorpheniramine [ 4 5 6 ]. The mechanisms are still unclear, but IgE-mediated mechanisms have been suggested.…”

Anaphylaxis to Chlorpheniramine Maleate and Literature Review

“…There have been many reports of urticaria due to antihistamines but cases of anaphylaxis are rare, particularly to CPM. Only a few cases have been reported in English medical literature ( Table 1 ) 4 5 6 7 8 9 10 11 12 13 14 15 .…”

<p>Lichenoid Reaction Caused by Antihistamines and Corticosteroids</p>

“…3 Despite the tolerability and safety of H 1 antihistamines in humans having been widely established, hypersensitivity reactions have been reported since the 1940s. [4][5][6] But LR induced by antihistamines and corticosteroids is rarely reported. 7,8 Here, we report a rare case of LR in a 32-year-old adult female, caused by antihistamines (cetirizine, loratadine) and corticosteroid (methylprednisolone) that were given to the patient for food allergy (seafood, eggs) treatment.…”