Hypersensitivity to H<sub>1</sub>‐antihistamines

Demoly, Pascal; Messaad, D.; Benahmed, S.; Sahla, H.; Bousquet, Jean

doi:10.1034/j.1398-9995.2000.00651.x

Cited by 15 publications

(12 citation statements)

References 4 publications

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“…In the past reports of H 1 ‐antihistamine‐induced urticaria, most of the causative drugs were either piperidine derivatives or piperazine derivatives. However, diphenhydramine, mequitazine and loratadine were also found to be causative in the current study 1,4,5 . In addition, Demoly et al.…”

Section: Discussioncontrasting

confidence: 39%

“…H 1 ‐antihistamines, widely used as anti‐allergic drugs, rarely cause adverse cutaneous reactions such as maculo‐papular eruptions, photosensitivity and fixed eruption. However, a few cases of multiple H 1 ‐antihistamine‐induced urticaria have been reported 1,2 . We report herein a case of urticarial reactions due to multiple antihistamines, including fexofenadine, loratadine, bepotastine and cetirizine, which belong to the second generation of antihistamines.…”

Section: Introductionmentioning

confidence: 96%

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Multiple H₁‐antihistamine‐induced urticaria

Inomata

Tatewaki

Ikezawa

2009

The Journal of Dermatology

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H(1)-antihistamines are widely used in the treatment of various allergic diseases. Particularly, a cornerstone of the management of chronic idiopathic urticaria is treatment with H(1)-antihistamines. However, a few cases of H(1)-antihistamine-induced urticaria have been reported. A 34-year-old woman presented with a 4-month history of recurrent urticaria, which was prominently exacerbated by the administration of H(1)-antihistamines. The patient consented to a provocation test of fexofenadine among drugs including cetirizine and hydroxyzine, which were suspected of inducing severe symptoms in episodes. One hour after challenge with 12 mg fexofenadine (one-fifth of the therapeutic dose), a urticarial reaction rapidly developed on nearly the entire body with remarkably increased levels of plasma histamine (190 nmol/L) and plasma leukotriene B4 (150 pg/mL). In challenge tests with other antihistamines, generalized urticaria occurred 5 and 1 h after intake of 10 mg loratadine and 10 mg bepotastine, respectively, whereas challenges with chlorpheniramine, mequitazine and azelastine were all negative. Skin prick tests with H(1)-antihistamines used in the challenges were all negative, indicating that the urticarial reactions after challenges with the causative drugs might not be immunoglobulin E-mediated. Among the causative drugs in our case, cetirizine and hydroxyzine are the piperazine derivatives, whereas fexofenadine, bepotastine, ebastine and loratadine are the piperidine derivatives. The chemical structures of both derivatives are very similar. Therefore, in this case, H(1)-antihistamine-induced urticaria may have been due to cross-reactivity between metabolites of these drugs, but not to drugs before metabolization. Hypersensitivity to H(1)-antihistamines should be considered when urticarial lesions worsen after H(1)-antihistamine treatment.

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Section: Discussioncontrasting

confidence: 39%

Section: Introductionmentioning

confidence: 96%

Multiple H₁‐antihistamine‐induced urticaria

Inomata

Tatewaki

Ikezawa

2009

The Journal of Dermatology

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“…In contrast, hypersensitivity to alkylamine derivatives such as chlorpheniramine is extremely rare,7,8 particularly a type I reaction 9. Recently, in Korea, the case of a 42-year-old male displaying urticaria, angioedema, dyspnea, and hypotension after ingesting chlorpheniramine and cetylpyridium was reported; this patient also suffered from aspirin-intolerant asthma 10.…”

Section: Discussionmentioning

confidence: 99%

“…Several cases of hypersensitivity reactions against piperazine derivatives such as cetirizine, hydroxyzine, levocetirizine, and loratadine have been reported 3-6. However, hypersensitivity reactions to alkylamine derivatives such as chlorpheniramine maleate are extremely rare, particularly a type I reaction 7,8. To date, only one case of chlorpheniramine-induced type I hypersensitivity with aspirin intolerance has been reported.…”

Section: Introductionmentioning

confidence: 99%

A Case of Chlorpheniramine Maleate-Induced Hypersensitivity With Aspirin Intolerance

Kim

Lee

et al. 2011

Allergy Asthma Immunol Res

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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.

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“…All these substances have been incriminated as inducing mild or severe allergic reactions, namely bupivacaine, hydrocortisone, methylergometrine, midazolam, oxytocin, pethidine, pheniramine, ranitidine, lactated ringer, and theophylline. [11121314151617181920]…”

Section: The More Drugs the Easier Anaphylaxismentioning

confidence: 99%

The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes

Kounis¹,

Mazarakis²,

Almpanis³

et al. 2014

J Nat Sc Biol Med

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Kounis syndrome is a condition that combines allergic, hypersensitivity, anaphylactic or anaphylactoid reactions with acute coronary syndromes including vasospastic angina, acute myocardial infarction and stent thrombosis. This syndrome is a ubiquitous disease affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Drugs, environmental exposures and various conditions are the main offenders. Clinical and therapeutic paradoxes concerning Kounis syndrome therapy, pathophysiology, clinical course and causality have been encountered during its clinical course. Drugs that counteract allergy, such as H2-antihistamines, can induce allergy and Kounis syndrome. The more drugs an atopic patient is exposed to, the easier and quicker anaphylaxis and Kounis syndrome can occur. Every anesthetized patient is under the risk of multiple drugs and substances that can induce anaphylactic reaction and Kounis syndrome. The heart and the coronary arteries seem to be the primary target in severe anaphylaxis manifesting as Kounis syndrome. Commercially available adrenaline saves lives in anaphylaxis but it contains as preservative sodium metabisulfite and should be avoided in the sulfite allergic patients. Thus, careful patient past history and consideration for drug side effects and allergy should be taken into account before use. The decision to prescribe a drug where there is a history of previous adverse reactions requires careful assessment of the risks and potential benefits.

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Hypersensitivity to H₁‐antihistamines

Cited by 15 publications

References 4 publications

Multiple H₁‐antihistamine‐induced urticaria

Multiple H₁‐antihistamine‐induced urticaria

A Case of Chlorpheniramine Maleate-Induced Hypersensitivity With Aspirin Intolerance

The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes

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Hypersensitivity to H1‐antihistamines

Cited by 15 publications

References 4 publications

Multiple H1‐antihistamine‐induced urticaria

Multiple H1‐antihistamine‐induced urticaria

A Case of Chlorpheniramine Maleate-Induced Hypersensitivity With Aspirin Intolerance

The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes

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Product

Resources

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Hypersensitivity to H₁‐antihistamines

Multiple H₁‐antihistamine‐induced urticaria

Multiple H₁‐antihistamine‐induced urticaria