Challenge-based pregabalin induced urticaria and angioedema. A case report

Ortega-Camarero, M.A.; Avila, Robledo; Castaño, M Prados; Piñero, M. Ruíz; Quiralte, Joaquín; Cimbollek, S

doi:10.1016/j.aller.2011.09.012

Cited by 6 publications

(8 citation statements)

References 6 publications

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“…Adverse reactions to PG are usually dose‐related; in our case, the rash appeared after the dose had been increased. Five cases with skin reactions that were not biopsied have been published (Supporting Information Table S1); in our case, the results of the biopsy support the diagnosis of a cutaneous adverse drug reaction.…”

Section: Discussionsupporting

confidence: 71%

First case of skin allergy to pregabalin with positive patch test reaction

et al. 2019

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K E Y W O R D S : allergy, case report, patch tests, pregabalin, rash Pregabalin (PG) is a antiepileptic drug with a structure similar to gabapentin, providing analgesic effects in patients with neuropathic conditions. 1 CASE REPORTA 51-year-old female patient was treated with PG (Lyrica) at 25 mg/day for 3 weeks and at 75 mg/day during a fourth week. After a month of treatment, a maculopular rash developed in the nape, neck, ears, arms, knees and ankles that improved after the withdrawal of the drug and administration of deflazacort 30 mg for 5 days. A biopsy of skin lesions showed superficial perivascular lymphocytic dermatitis with some eosinophil and some lymphocyte permeation in the epidermis.Patch tests with PG (Lyrica) 5% pet. and aq., respectively, in the dorsal region of the left arm were read on day (D) 2 and D4. These remained negative; however, on D3, the patient noted a rash similar to the rash that developed when she was taking PG, particularly on the back of the right forearm. A patch test with placebo (pet.) gave negative results on D2 and D4. A subsequent patch test with PG (5% pet.) on the right forearm where the rash reappeared gave positive results in terms of a ++ reaction on D2 and a +++ reaction on D4, whereas a similar lesional patch test with PG aq. on the right forearm remained negative. The diagnosis of erythematous maculopapular rash caused by type IV hypersensitivity to PG was made. DISCUSSIONAdverse reactions to PG are usually dose-related 2 ; in our case, the rash appeared after the dose had been increased. Five cases with skin reactions that were not biopsied have been published (Supporting Information Table S1) 1-5 ; in our case, the results of the biopsy support the diagnosis of a cutaneous adverse drug reaction.It is of note that, similarly to what is seen in fixed drug eruption testing, where, commonly, patch testing gives positive results only in the area where the rash appears, owing to activation of intraepidermal CD8 + memory T cells at these sites, 6 our patient showed a clear positive reaction only on lesional skin. Lacosamide, a third-generation antiepileptic drug, may be a useful alternative to PG, 7 if tolerance is confirmed prior to prescription. CONFLICTS OF INTERESTThe authors have no conflicts of interest to report. REFERENCES 1. Smith TL, Baldwin A, Cunningham LL Jr, Cook AM. Rash associated with pregabalin use. Ann Pharmacother. 2008;42:1899-1902. 2. Bamanikar A, Dhobale S, Lokwani S. Pregabalin hypersensitivity in a patient treated for postherpetic neuralgia. Indian J Pharmacol. 2013;45: 522-523. 3. Yoshioka M, Okura R, Hino R, Nakamura M. A case of drug eruption due to pregabalin. J Clin Dermatol. 2013;67:569-572. 4. Inoue A, Sawda Y, Ohmori S, et al. Maculopapular type drug eruption caused by pregabalin: a case and literature review. Allergol Int. 2016;65: 351-352. 5. Ortega-Camarero MA, Avila R, Prados Castaño M, Piñero M, Quiralte J, Cimbollek S. Challenge-based pregabalin induced urticaria and angioedema. A case report. Allergol Immunopathol (Madr). 2012; 4...

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Section: Discussionsupporting

confidence: 71%

First case of skin allergy to pregabalin with positive patch test reaction

et al. 2019

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“…4 Reported cases of cutaneous hypersensitivity reactions caused by pregabalin generally occur within 2 weeks of initiating medication. [5][6][7][8][9][10][11][12] We report a rare case of a delayed cutaneous hypersensitivity reaction caused by pregabalin, which was confirmed by a drug provocation test. An elderly patient with severe herpes zoster (HZ) neuralgia developed maculopapular drug eruption covering 80% to 90% of the total body surface area after 40 days of combined multidrug analgesia.…”

Section: Introductionmentioning

confidence: 78%

“…To the best of our knowledge, eight cases of cutaneous hypersensitivity reactions caused by pregabalin have been reported. [5][6][7][8][9][10][11][12] Three of Figure 3. Timeline of the patient's medications.…”

Section: Discussionmentioning

confidence: 99%

“…these cases occurred within 1 week, 5,6,12 three within 2 weeks, 7,9,10 and one within 4 weeks after initiating medication, 8 and the time interval was not reported in one case. 11 In patients who are not previously sensitized, the onset of maculopapular drug eruption occurs within 4 to 14 days after the start of exposure, but rarely occurs at weeks to months. 21 In this patient, the latency period was 40 days, which may have been due to a difference in drug metabolism or polymorphisms in some unknown gene.…”

Section: Discussionmentioning

confidence: 99%

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Pregabalin-induced delayed cutaneous hypersensitivity reaction occurring after 40 days of use: a case report

Zhang,

Du,

et al. 2024

J Int Med Res

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Pregabalin is the first-line treatment for neuropathic pain. Cases of cutaneous hypersensitivity reactions caused by pregabalin generally occur within 2 weeks of initiating medication. We report a rare case of a delayed cutaneous hypersensitivity reaction caused by pregabalin, which was confirmed by a drug provocation test. A 72-year-old man with severe herpes zoster neuralgia developed maculopapular drug eruption covering 80% to 90% of his total body surface area after 40 days of combined multidrug analgesia. A drug provocation test for pregabalin was positive. The time interval between initiating medication and the onset of the patient’s rash was the longest and he also had the largest area of skin affected compared with patients with a similar condition in previous related reports. Remaining vigilant for possible adverse cutaneous hypersensitivity reactions during treatment is important because of the long-term course of pregabalin treatment for neuropathic pain.

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“…7 Immediate-type reactions such as urticaria, angioedema and anaphylaxis due to AEDs are very rare compared to delayed-type reactions. 1,[8][9][10][11] Standardised diagnosis of these reactions includes first skin prick and intrardermal tests, respectively, and if negative, DPT is recommended. 1,12 We performed prick-intradermal tests, respectively, with the same levetiracetam commercial drug (Keppra® 500mg/5ml) administered to our patient at the time of reaction, and all tests were negative.…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis to levetiracetam in an adolescent: a very rare occurence

et al. 2021

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Antiepileptic drug (AED)-induced hypersensitivity reactions(HSR) which are reported to be more common in children, present with a variety of clinical manifestations ranging from benign maculopapular exanthems to severe delayed reactions such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), Drug Reaction with Eosinophilia and Systemic Symptoms(DRESS) and also organ-specific disease such as agranulocytosis and drug-induced liver injury. 1 Immediate-type HSRs such as urticaria/ angioedema or anaphylaxis are very rare with AEDs. Delayed reactions are more commonly seen with aromatic AEDs like phenytoin and carbamazepine than the new generation or non-aromatic AEDs. 1 Levetiracetam is an increasingly used new non-aromatic AEDs and reported to have a safer tolerability profile in daily practice. 2 Here, we report an adolescent case of anaphylaxis due to levetiracetam, in order to point out that new AEDs can result in HSRs and also, severe immediate reactions should be expected Case ReportA 15-year-old girl with no previous diagnosis of epilepsy presented to the pediatric emergency department with a history of two seizures in the same day. Later in the emergency department, the patient experienced another seizure with jaw-locking, nystagmus, spasms in legs and arms

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Challenge-based pregabalin induced urticaria and angioedema. A case report

Cited by 6 publications

References 6 publications

First case of skin allergy to pregabalin with positive patch test reaction

First case of skin allergy to pregabalin with positive patch test reaction

Pregabalin-induced delayed cutaneous hypersensitivity reaction occurring after 40 days of use: a case report

Anaphylaxis to levetiracetam in an adolescent: a very rare occurence

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