Maculopapular and urticarial eruption from cetirizine

Urticarial Reaction to the Antihistamine Levocetirizine Dihydrochloride

“…Cetirizine is a second-generation antihistamine very commonly prescribed by dermatologists, ENT specialists and even general practitioners, which is also sold as an over-the-counter drug in some European countries because of its very good safety profile. However, recently some cases with maculopapular eruption, multilocalized fixed drug eruption and localized as well as generalized urticaria caused by cetirizine have been reported [5][6][7][8][9]. While a delayed-type sensitization to this drug in some of these cases had been proven [5,6], an IgE-dependent mechanism remains speculative [8,9].…”

“…This is remarkable since we suggest that our finding might be explainable by the fact that levocetirizine is only an enantiomer of cetirizine and that cetirizine as well as levocetirizine share the piperazinic ring, well known as an antigen ( fig. 2) [5].…”

Cutaneous drug eruption from cetirizine and hydroxyzine

“…Hydroxyzine is an ethylenediamine dihydrochloride (Fig 4). 1,8 Despite the structural similarity of the 2 antihistamines, crossreactions among ethylenediamine, hydroxyzine, and cetirizine are rarely reported. 4 Although Stingeni et al 8 suggested cross-reactions by positive patch test to cetirizine 2.5% and hydroxyzine 1%, the case did not report a drug eruption from both cetirizine and hydroxyzine.…”

“…[8][9][10][11][12][13][14][15][16][17][18][19][20] According to the reports, drug eruption from cetirizine, unlike eruptions from hydroxyzine and other drugs, is usually in the form of urticaria. Because of that, it is sometimes misinterpreted as urticaria that fails to respond to antihistamines.…”

Clinicopathologic Features of Systemic Contact Dermatitis from Ethylenediamine in Cetirizine and Levocetirizine

“…Although cetirizine is well tolerated when administered orally, it can rarely cross-react with other piperazine derivatives and cause a drug eruption [5] , usually in the form of urticaria or fixed drug eruption. To our knowledge, only 8 cases of skin eruption due to cetirizine have been reported so far [2,[5][6][7][8][10][11][12] ; moreover, only 2 adverse reactions have recently been reported with levocetirizine (a case of fixed drug eruption [3] and a case of urticaria [9] ).…”