A case of levocetirizine-induced fixed drug eruption and cross-reaction with piperazine derivatives
10.5415/apallergy.2013.3.4.281
- Author:
Mi Yeong KIM
1
;
Eun Jung JO
;
Yoon Seok CHANG
;
Sang Heon CHO
;
Kyung Up MIN
;
Sae Hoon KIM
Author Information
1. Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Korea.
- Publication Type:Case Report
- Keywords:
Levocetirizine;
Fixed drug eruption;
Antihistamine
- MeSH:
Acetaminophen;
Aged;
Carbon;
Cetirizine;
Chlorpheniramine;
Common Cold;
Drug Eruptions;
Drug-Related Side Effects and Adverse Reactions;
Exanthema;
Female;
Guaifenesin;
Histamine Antagonists;
Humans;
Hydroxyzine;
Hypersensitivity;
Loratadine;
Magnesium;
Patch Tests;
Pigmentation;
Pruritus;
Pseudoephedrine;
Triprolidine
- From:
Asia Pacific Allergy
2013;3(4):281-284
- CountryRepublic of Korea
- Language:English
-
Abstract:
Fixed drug eruption is an uncommon adverse drug reaction caused by delayed cell-mediated hypersensitivity. Levocetirizine is an active (R)-enatiomer of cetirizine and there have been a few reports of fixed drug eruption related to these antihistamines. We experienced a case of levocetirizine-induced fixed drug eruption and cross-reaction with other piperazine derivatives confirmed by patch test. A 73-year-old female patient presented with recurrent generalized itching, cutaneous bullae formation, rash and multiple pigmentation at fixed sites after taking drugs for common cold. She took bepotastine besilate (Talion®) and levocetirizine (Xyzal®) as antihistamine. She took acetaminophen, pseudoephedrine 60 mg / triprolidine 2.5 mg (Actifed®), dihydrocodeinebitartrate 5 mg / di-methylephedrine hydrochloride 17.5 mg / chlorpheniramine maleate 1.5 mg / guaifenesin 50 mg (Codening®) and aluminium hydroxide 200 mg / magnesium carbonate 120 mg (Antad®) at the same time. Patch test was done with suspected drugs and the result was positive with levocetirizine. We additionally performed patch test for other antihistamines such as cetirizine, hydroxyzine, fexofenadine and loratadine. Piperazine derivatives (cetirizine and hydroxyzine) were positive, but piperidine derivatives (fexofenadine and loratadine) were negative to patch test. There was no adverse drug reaction when she was challenged with fexofenadine. We report a case of levocetirizine-induced fixed drug eruption confirmed by patch test. Cross-reactions were only observed in the piperazine derivatives and piperidine antihistamine was tolerant to the patient.
