Fixed Drug Eruption due to Achiote Dye

Abstract

Fixed drug eruption (FDE) is a localized type IV sensitivity reaction to a systemically introduced allergen. It usually occurs as a result of new medication, making identification and avoidance of the trigger medication straightforward; however, in a rare subset of cases no pharmacological source is identified. In such cases, the causative agent is often a food or food additive. In this report we describe a case of a FDE in a 12-year-old girl recently immigrated to the United States from Ecuador who had no medication exposure over the course of her illness. Through an exhaustive patient history and literature review, we were able to hypothesize that her presentation was caused by a dietary change of the natural achiote dye used in the preparation of yellow rice to a locally available commercial dye mix containing tartrazine, or Yellow 5, which has previously been implicated in both systemic hypersensitivity reactions and specifically in FDE. This report adds to the small body of available literature on non-pharmacological fixed hypersensitivity eruptions and illustrates an effective approach to the management of such a presentation when history is not immediately revealing.

Multiple Fixed Drug Eruption Due to Piroxicam: A Brief Case Report

“…These lesions persist until the 96-hour patch test reading (Figure 3). This is in accordance with the reference which states that the positive results are at least 6 hours and FDE lesions generally experience resolution within seven to ten days so that the lesion will still be found on the fourth day after provocation (96 hours) [10]. Piroxicam is a Non-steroidal Anti-inflammatory Drug (NSAID) which belongs to the oxicam group [17].…”

“…These initial lesions can appear anywhere in the body and some case reports mention that the first lesion can appear in areas of previous trauma, burns, insect bites, or vaccination [8,9]. Termination of the causative drug can cause resolution in 7 to 10 days [10].…”

Triggers, clinical manifestations and assessment of paediatric fixed drug eruptions: A systematic review of the literature

“…Contaminants or food additives were incriminated in a few cases, including tartrazine-containing food in two patients. 12,13 Multiple culprit drugs were suspected in nine cases. Most patients had multiple lesions (75.6%).…”

Fixed Drug Eruptions With Flavoured Liquid Formulations of Over-the-Counter Analgesics: A Case Report

“…While acetaminophen and NSAIDs are thought to be one of the most common triggers for the variable forms of FDEs [ 1 , 6 ], other culprits, including antibiotics and anti-epileptics, are also reported with variable frequency. Dyes and colouring agents were implicated in many reactions, including both immediate and delayed [ 15 , 16 ], but no specific case reports with successful challenges. There have been variable reports about the reactions, ranging from the typical presentation to other unique but individual presentations, such as the aforementioned eyelid necrosis [ 11 ].…”