INTRODUCTIONFew reports have documented allergic hypersensitivity reactions after barium gastrointestinal studies. Of these, the barium suspension, its additives or intravenous glucagon given for bowel relaxation has been implicated as possible allergens. We report a patient with delayed hypersensitivity reaction after barium enema and discuss the reasons supporting glucagon as the possible allergen.

CLINICAL PICTUREA 74-year-old Chinese woman presented with pruritic rashes, 1 day after a barium enema. Intravenous glucagon (GlucaGen, Novo Nordisk, Denmark) was administered during the barium enema. Physical examination revealed palpable purpuric rashes on the legs with erythematous papules and plaques on the arms and trunk. Skin biopsy demonstrated superficial perivascular infiltrates of lymphocytes and eosinophils, consistent with a drug eruption.

TREATMENT AND OUTCOMEThe rashes resolved with antihistamines and topical corticosteroids.

CONCLUSIONThis report highlights the potential of glucagon to cause hypersensitivity reactions. Awareness of this entity is important for the prevention and recognition of complications during barium gastrointestinal studies.

Adrenal Cortex Hormones ; therapeutic use ; Aged ; Barium Compounds ; Drug Hypersensitivity ; etiology ; Enema ; Female ; Glucagon ; administration & dosage ; adverse effects ; Histamine H1 Antagonists ; therapeutic use ; Humans ; Hypersensitivity, Delayed ; etiology ; Injections, Intravenous ; Parasympatholytics ; administration & dosage ; adverse effects ; Time Factors

INTRODUCTIONLeg ulcers are a chronic condition affecting the older population. In Singapore, the use of topical traditional Chinese medicaments (TTCM) is common amongst those older than 65 years of age. We study the role of TTCM as contact sensitisers in patients with chronic venous leg ulcers and its impact in the clinical management of these patients.

MATERIALS AND METHODSPatients with chronic leg ulcers attending the Wound and Ulcer Clinic at the National Skin Centre (NSC) between October 2005 and April 2006 were patch-tested to the NSC TTCM series. They were also patch-tested for other allergens from the NSC Standard Series, Medicament Series, Steroid Series and wound dressings.

RESULTSA total of 44 patients were patch-tested. Seventeen of the 44 (38.7%) patients were using or had used at least 1 TTCM. Seven patients (15.9%) had at least 1 positive patch test (PT) reading to TTCM, giving a sensitisation rate of 41% (7 of 17). A significantly high proportion of the patients, 94.1% (16 of 17) with a positive history of TTCM usage had at least 1 positive PT reading compared to those without a history of TTCM usage, 45.8% (11 of 24).

CONCLUSIONTTCM play an important role as contact sensitisers in our patients with chronic venous leg ulcers and may be a significant factor in non- or poor-healing leg ulcers. In such patients, a history of TTCM usage should be sought for and patch testing should include the commonly used TTCM where relevant.

Administration, Topical ; Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Cohort Studies ; Cross-Sectional Studies ; Dermatitis, Allergic Contact ; epidemiology ; Female ; Humans ; Leg Ulcer ; drug therapy ; Male ; Medicine, Chinese Traditional ; adverse effects ; Middle Aged ; Singapore ; epidemiology ; Varicose Ulcer ; drug therapy