Chlorpheniramine maleate is commonly used antihistamine. Since antihistamines are the main therapeutic agents for symptomatic treatment of urticaria, anaphylaxis to antihistamines may lead to errors in diagnosis and treatment. We report a case of anaphylaxis induced by chlorpheniramine maleate confirmed by intradermal test. A 35-year-old female experienced history of anaphylaxis after intramuscular injection of chlorpheniramine maleate. Skin prick test was negative, but intradermal test was positive. Patient also experienced mild dizziness after intradermal test and refused to perform any further evaluation such as oral challenge test. Anaphylaxis for chlorpheniramine maleate is very rare but should be considered.
Adult ; Anaphylaxis ; Chlorpheniramine ; Diagnosis ; Dizziness ; Female ; Histamine Antagonists ; Humans ; Injections, Intramuscular ; Intradermal Tests ; Skin ; Urticaria

Both immediate and nonimmediate type hypersensitivity reactions (HRs) with a single dose of quinolone in the same patient have not been previously reported. A 47-year-old female patient referred to us because of the history of a nonimmediate type HR to radio contrast agent and immediate type HR to clarithromycin. She experienced anaphylaxis in minutes after the second dose of 50 mg when she was provocated with moxifloxacin. She was treated immediately with epinephrine, fluid replacement and methylprednisole and pheniramine. On the following day she came with macular eruptions, and she was treated with methylprednisolone. The positive patch test performed with moxifloxacin as well as the lymphocyte transformation test proved the T-cell mediated HR. In order to prove the immediate type HR, basophil activation test was performed but was found negative. This case report presents for the first time the 2 different types of HRs in a patient with a test dose of quinolone.
Anaphylaxis ; Basophils ; Clarithromycin ; Epinephrine ; Female ; Humans ; Hypersensitivity ; Lymphocyte Activation ; Methylprednisolone ; Middle Aged ; Patch Tests ; Pheniramine ; T-Lymphocytes

PURPOSE: The authors report a case of bilateral simultaneous acute angle closure attack following administration of an over-the-counter common cold medication (ingredients: chlorpheniramine maleate, phenylephrine hydrochloride, and belladonna alkaloid). CASE SUMMARY: A 67-year-old man visited the emergency room with a sudden onset of bilateral blurred vision and ocular pain accompanied by headache, nausea, and vomiting. He had taken an over-the-counter common cold medication three times per day for three days before the visit. His visual acuity was 0.3 and 0.7 and intraocular pressure (IOP) was 50 mm Hg and 40 mm Hg in right and left eye, respectively. The refraction in manifest refractive test was +0.75 D sph = -0.75 D cyl x 100 in right eye and +1.25 D sph = -1.25 D cyl x 80 in left eye. The anterior chamber depth was three times the corneal thickness in center and less than 1/4 of the corneal thickness in periphery in both eyes on van Herick method. The angles of both eyes were closed on gonioscopy. He was treated with ocular hypotensive medication and miotics followed by withdrawal of common cold medications. After 10 days, bilateral neodymium-doped yttrium aluminium garnet (Nd:YAG) laser peripheral iridotomies were done. During four months of follow-up, there was no recurrence of angle closure attack, and normal IOP was maintained without glaucoma medications. CONCLUSIONS: Common cold medications which are easily accessible can induce acute angle closure attack in those who are predisposed to develop angle closure attacks, hence attention must be taken in those people when taking common cold medications.
Aged ; Anterior Chamber ; Atropa belladonna ; Chlorpheniramine ; Common Cold* ; Emergency Service, Hospital ; Follow-Up Studies ; Glaucoma ; Gonioscopy ; Headache ; Humans ; Intraocular Pressure ; Miotics ; Nausea ; Phenylephrine ; Recurrence ; Visual Acuity ; Vomiting ; Yttrium

Second-generation antihistamines are widely prescribed for the control of symptoms of allergic inflammation such as itchy hives, coryza, and itchy eyes. In rare circumstances, these drugs might provoke allergic inflammation. Hypersensitivity to bepotastine besilate, a second-generation antihistamine has never been reported. A 17-year-old schoolgirl, whose paroxysmal itchy hives had been controlled with bepotastine, experienced aggravation of the hives. An oral provocation test confirmed her hypersensitivity to bepotastine and cross-reactivity to levocetirizine. She showed no reaction to chlorpheniramine, ketotifen, or olopatadine among the 13 antihistamines tested. While searching for an antihistamine to control her itchy hives, we found that she also exhibited cross-reactivity to various antihistamines with different chemical structures from that of bepotastine, which is not predicted according to the chemical classification of antihistamines. We report a case of hypersensitivity to bepotastine besilate in a patient with chronic spontaneous urticaria.
Adolescent ; Chlorpheniramine ; Classification ; Drug Hypersensitivity ; Histamine Antagonists ; Humans ; Hypersensitivity ; Inflammation ; Ketotifen ; Olopatadine Hydrochloride ; Urticaria

Although hypersensitivity reactions to iodinated contrast media (ICM) are uncommon, their clinical impacts are considerable because of their wide use and potential fatality. The best way to prevent ICM-induced hypersensitivity is to avoid re-exposure to the ICM. However, ICM use is inevitable in the evaluation of many diseases. A 64-year-old male with renal cell carcinoma presented with anaphylaxis after computed tomography (CT) using iohexol. Intradermal test results were positive to iohexol, iomeprol, and ioversol. The following 3 CT scans using the test-negative agents iopromide, iopamidol, and iobitridol still provoked hypersensitivity reactions despite premedication using intravenous antihistamine and corticosteroid. For the next step, iodixanol, a nonionic iso-osmolar dimer, was tested by intravenous graded challenges in addition to the intradermal skin test, which and was confirmed to be negative. The patient underwent CT scan using iodixanol after premedication with chlorpheniramine 4 mg and methylprednisolone 40 mg, and hypersensitivity reactions did not recur. We report a case of a patient showing hyper reactivity to multiple ICMs despite negative intradermal skin tests, who eventually underwent successful enhanced CT scans after choosing ICM by the graded challenge test.
Anaphylaxis* ; Carcinoma, Renal Cell ; Chlorpheniramine ; Contrast Media* ; Humans ; Hypersensitivity ; Intradermal Tests ; Iohexol ; Iopamidol ; Male ; Methylprednisolone ; Middle Aged ; Premedication ; Skin Tests ; Tomography, X-Ray Computed

OBJECTIVES: The present study assessed the prevalence of the potentially inappropriate medication (PIM) use in Korean elderly patients with Parkinson's disease. In addition, this study examined risk factors that affect PIM use. METHOD: A retrospective, observational study was conducted using Korean National Health Insurance claims database of 2009. PIM use in Parkinson's disease patients aged 65 years or older was examined based on 2012 Beers Criteria. Multivariable logistic regression was conducted to identify risk factors for PIM use. RESULTS: Among 5,277 elderly patients with Parkinson's disease, 88.9% of patients used PIM(s) at least once. The average number of PIM items used per patient was 4.2. PIM use ratio, the proportion of total amount of PIMs to all medications per patient, was 12.6%. Frequently used PIM therapeutic classes were benzodiazepines (32.7%), first-generation antihistamines (19.2%), and prokinetics (17.5%). Individual PIMs most commonly used included chlorpheniramine (11.4%), levosulpiride (10.9%), diazepam (9.0%), and alprazolam (7.6%). Women (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.11-1.16), medical aid (OR 1.18, 95% CI 1.15-1.21), and long-term facilities (OR 2.43, 95% CI 2.22-2.65) were shown to be risk factors associated with PIM use. Of particular, wide variation in PIM use was associated with the types of healthcare facility. CONCLUSION: The PIM prevalence was very high in elderly Parkinson's disease patients. Nationally effective and systematic efforts to identify and prevent PIM use should be made to ensure patient safety and to improve quality of care in the elderly.
Aged* ; Alprazolam ; Beer ; Benzodiazepines ; Chlorpheniramine ; Delivery of Health Care ; Diazepam ; Female ; Histamine Antagonists ; Humans ; Logistic Models ; National Health Programs ; Observational Study ; Parkinson Disease* ; Patient Safety ; Prevalence ; Retrospective Studies ; Risk Factors

Bee pollen is pollen granules packed by honey bees and is widely consumed as natural healthy supplements. Bee pollen-induced anaphylaxis has rarely been reported, and its allergenic components have never been studied. A 40-year-old male came to the emergency room with generalized urticaria, facial edema, dyspnea, nausea, vomiting, abdominal pain, and diarrhea 1 hour after ingesting one tablespoon of bee pollen. Oxygen saturation was 91%. His symptoms resolved after injection of epinephrine, chlorpheniramine, and dexamethasone. He had seasonal allergic rhinitis in autumn. Microscopic examination of the bee pollen revealed Japanese hop, chrysanthemum, ragweed, and dandelion pollens. Skin-prick with bee pollen extracts showed positive reactions at 0.1 mg/mL (A/H ratio > 3+). Serum specific IgE to ragweed was 25.2, chrysanthemum 20.6, and dandelion 11.4 kU/L; however, Japanese hop, honey-bee venom and yellow-jacket venom were negative (UniCAP(R), Thermo Fisher Scientific, Uppsala, Sweden). Enzyme-linked immunosorbent assay (ELISA) confirmed serum specific IgE to bee-pollen extracts, and an ELISA inhibition assay for evaluation of cross-allergenicity of bee pollen and other weed pollens showed more than 90% of inhibition with chrysanthemum and dandelion and ~40% inhibition with ragweed at a concentration of 1 microg/mL. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and IgE-immunoblot analysis revealed 9 protein bands (11, 14, 17, 28, 34, 45, 52, 72, and 90 kDa) and strong IgE binding at 28-34 kDa, 45 and 52 kDa. In conclusion, healthcare providers should be aware of the potential risk of severe allergic reactions upon ingestion of bee pollen, especially in patients with pollen allergy.
Abdominal Pain ; Adult ; Ambrosia ; Anaphylaxis* ; Asian Continental Ancestry Group ; Bees* ; Chlorpheniramine ; Chrysanthemum ; Dexamethasone ; Diarrhea ; Dyspnea ; Eating ; Edema ; Electrophoresis, Polyacrylamide Gel ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Epinephrine ; Health Personnel ; Honey ; Humans ; Humulus ; Hypersensitivity ; Immunoglobulin E ; Male ; Nausea ; Oxygen ; Pollen ; Rhinitis, Allergic, Seasonal ; Sodium Dodecyl Sulfate ; Taraxacum ; Urticaria ; Venoms ; Vomiting

Chlorpheniramine is a widely prescribed H1-antihistamine for relieving urticaria or histamine-mediated allergic reactions. However, although rare, it may cause immediate hypersensitivity reactions. The diagnosis is usually made by provocation test, but its application is often limited due to comorbidities or potential risk of severe reactions. In those cases, skin tests and basophil activation tests can be considered as additional diagnostic tests for the drug allergy. Here, we report a 33-year-old female with underlying chronic urticaria, who recurrently developed anaphylaxis after chlorpheniramine administration. Intradermal test showed positive responses in the patient at 0.02 mg/mL of chlorpheniramine, but not in healthy controls. Basophil activation test showed significant up-regulation of CD63 and CD203c by chlorpheniramine. The present case reminds the rare but potential allergic risk of chlorpheniramine, and also suggests the potential utility of basophil activation test in making the diagnosis.
Adult ; Anaphylaxis ; Basophils ; Chlorpheniramine ; Comorbidity ; Diagnosis ; Diagnostic Tests, Routine ; Drug Hypersensitivity ; Female ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Intradermal Tests ; Skin Tests ; Up-Regulation ; Urticaria

Anaphylaxis under general anesthesia is rare but can present as cardiovascular collapse, airway obstruction, and/or skin manifestation. A high level of suspicion is required for the recognition and prompt management and anaphylaxis can be diagnosed through clinical findings. The most common causes of anaphylaxis during general anesthesia are neuromuscular blocking agents, antibiotics, and latex. We present a case of anaphylactic shock following intravenous injection of cisatracurium and sufentanil. The patient was under anesthesia induction and within minutes after injection of these drugs, generalized erythema, bronchospasm, and severe hypotension developed. The Patient was managed with epinephrine, proper hydration, hydrocortisone, and pheniramine and the surgery was decided to be postponed. Subsequent surgery should be performed after conducting skin tests which can help identify the causal agents and determine alternative drugs. Anesthesiologists should be aware that not only expeditious diagnosis and management of anaphylaxis but also further evaluation in order to determine the safe method of subsequent anesthesia.
Airway Obstruction ; Anaphylaxis* ; Anesthesia* ; Anesthesia, General ; Anti-Bacterial Agents ; Bronchial Spasm ; Diagnosis ; Epinephrine ; Erythema ; Humans ; Hydrocortisone ; Hypotension ; Injections, Intravenous* ; Latex ; Neuromuscular Blocking Agents ; Pheniramine ; Shock ; Skin Manifestations ; Skin Tests ; Sufentanil*

Cytarabine is a very important chemotherapeutic agent for leukemia and lymphoma patients and is prescribed more frequently than before. Cytarabine-induced delayed-onset hypersensitivity may rarely present as non-IgE mediated anaphylaxis. However, we do not know yet whether desensitization therapy in adults may be effective in cytarabine-induced delayed-onset anaphylaxis. A 78-year-old woman who was diagnosed with acute myeloblastic leukemia had chemotherapy including cytarabine. In spite of premedication with hydrocortisone and chlorpheniramine, the patient had anaphylaxis a few hours after cytarabine infusion. We decided to perform desensitization therapy. After desensitization therapy using a newly designed protocol, the patient was tolerable to cytarabine infusion without hypotension or high fever. Desensitization therapy was successfully performed on an adult patient with delayed-onset anaphylaxis caused by cytarabine.
Adult ; Aged ; Anaphylaxis* ; Chlorpheniramine ; Cytarabine* ; Desensitization, Immunologic ; Drug Therapy ; Female ; Fever ; Humans ; Hydrocortisone ; Hypersensitivity ; Hypotension ; Leukemia ; Leukemia, Myeloid, Acute ; Lymphoma ; Premedication