Research letter
Urticaria caused by dimenhydrinate
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These symptoms disappeared in few hours after treatment with betamethasone 4<span class="elsevierStyleHsp" style=""></span>mg i.m. and oxatomide 30<span class="elsevierStyleHsp" style=""></span>mg orally. One month later the patient had another allergic reaction taking a dimenhydrinate chewing gum, the symptoms were similar to those of the first reaction but after 1<span class="elsevierStyleHsp" style=""></span>h, yet on this occasion, there was complete remission of the reaction only taking oral antihistamines.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was suffering from Behcet's disease (BD), a complex multisystem disease of unknown etiology, and Hashimoto's thyroiditis (HT) in treatment respectively with infliximab for six months and levothyroxine 100<span class="elsevierStyleHsp" style=""></span>mcg for nearly 23 years, moreover she reported hypertension and diabetes in treatment respectively with ramipril 5<span class="elsevierStyleHsp" style=""></span>mg/hydrochlorothiazide 25<span class="elsevierStyleHsp" style=""></span>mg for 4 years and metformin 500<span class="elsevierStyleHsp" style=""></span>mg for 2 years.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient's personal history was negative for allergic diseases other than episodes of erythema using a metal watch; moreover in the past she tolerated antihistamines from other groups (rupatidine, levocetirizine).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Therefore allergological evaluations were carried out including a skin prick test with commercial extracts (Stallergenes, Saronno, Varese, Italy) of the most common inhalants (house dust mites, moulds, <span class="elsevierStyleItalic">Parietaria judaica</span>, grass pollen, dog and cat dander) and food (milk proteins, egg yolk, egg white, cod, shrimp, <span class="elsevierStyleItalic">Anisakis simplex</span>, peanut, soybean, tomato, wheat flour, celery, carrot, potato, bean, eggplant, apple, orange). A patch test was conducted with commercial series: standard European series and preservatives (Lofarma, Milan, Italy); specific IgE antibodies (Phadia CAP System fluorimetric test, Uppsala, Sweden) for the above reported inhalants and food allergens. Skin prick tests and specific IgE for the most common inhalant and food allergens were negative as were patch tests.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was advised not to take dymenidrinate and she did not report any allergic reaction.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The temporal correlation, few hours between intake and clinical manifestations in both cases, and the absence of urticaria without drug assumption establish a probable cause-effect relationship between drug and urticaria according to the Naranjo algorithm (Naranjo score: 5).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">There are few known cases of dimenhydrinate allergic reactions exclusively characterised by fixed drug eruption (FDE).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4,5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We considered it important to report this case because the patient showed only urticaria and not erythema fixed as in the other cases cited; according to the new sub-classification of delayed type IV immune reactions, FDE is a type IVc reaction in which cytotoxic T cells play the predominant role,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> while the complex nature of the pathogenesis of urticaria has many features in addition to the release of histamine from dermal mast cells.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Therefore we can find in the clinical history of the patient a motivation for the singularity of the adverse reactions to this molecule. In fact on the one hand Lichting et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> showed that the number of mast cells is increased in reactive and spontaneous skin lesions of BD when compared with apparently normal skin of BD or those with other skin diseases. They also reported that mast cell degranulation might have a role in the pathogenesis of BD. On the other hand a cross-linking of IgE receptors of mast cells induced by anti-thyroid antibodies, in HT, may presumably be a cause of histamine release.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Therefore we referred this case for its singularity, as it is the first case, to our knowledge, of urticaria after taking dimenhydrate, while FDE is the clinical manifestation in the other cases cited. Probably its singularity is justified by the presence of BD and HT, which may create a state of mast cell instability, in our opinion, able to cause urticaria as clinical manifestation of dimenhydrate adverse reaction.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dimenhydrinate-induced fixed drug eruption in a patient who tolerated other antihistamines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Rodríguez-Jiménez" 1 => "J. Domínguez-Ortega" 2 => "J.M. González-García" 3 => "C. 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| 2016 May | 21 | 15 | 36 |
| 2016 April | 18 | 17 | 35 |
| 2016 March | 17 | 15 | 32 |
| 2016 February | 23 | 22 | 45 |
| 2016 January | 19 | 19 | 38 |
| 2015 December | 18 | 14 | 32 |
| 2015 November | 17 | 14 | 31 |
| 2015 October | 19 | 11 | 30 |
| 2015 September | 20 | 6 | 26 |
| 2015 August | 14 | 7 | 21 |
| 2015 July | 23 | 3 | 26 |
| 2015 June | 5 | 0 | 5 |
| 2015 May | 10 | 3 | 13 |
| 2015 April | 8 | 3 | 11 |
| 2015 March | 15 | 3 | 18 |
| 2015 February | 3 | 0 | 3 |
| 2015 January | 16 | 2 | 18 |
| 2014 December | 19 | 6 | 25 |
| 2014 November | 12 | 4 | 16 |
| 2014 October | 14 | 1 | 15 |
| 2014 September | 20 | 7 | 27 |
| 2014 August | 15 | 0 | 15 |
| 2014 July | 19 | 2 | 21 |
| 2014 June | 10 | 0 | 10 |
| 2014 May | 9 | 1 | 10 |
| 2014 April | 5 | 7 | 12 |
| 2014 March | 32 | 13 | 45 |
| 2014 February | 18 | 8 | 26 |
| 2014 January | 22 | 5 | 27 |
| 2013 December | 36 | 8 | 44 |
| 2013 November | 19 | 3 | 22 |
| 2013 October | 45 | 13 | 58 |
| 2013 September | 44 | 8 | 52 |
| 2013 August | 44 | 12 | 56 |
| 2013 July | 37 | 6 | 43 |
| 2013 June | 23 | 4 | 27 |
| 2013 May | 24 | 9 | 33 |
| 2013 April | 19 | 11 | 30 |
| 2013 March | 17 | 6 | 23 |
| 2013 February | 10 | 8 | 18 |
| 2013 January | 6 | 1 | 7 |
| 2012 December | 8 | 1 | 9 |
| 2012 November | 3 | 5 | 8 |
| 2012 October | 2 | 2 | 4 |
| 2012 September | 3 | 3 | 6 |
| 2012 June | 365 | 0 | 365 |
Show all
