芬太尼TTS过敏性接触性皮炎,对全身芬太尼有良好的耐受性。

IF 4.2 Q3 Pharmacology, Toxicology and Pharmaceutics
Patricia Rojas-Pérez-Ezquerra, Sarah Micozzi, Ines Torrado-Español, Ana Rodríguez-Fernández, Vicente Albéndiz-Gutiérrez, Blanca Noguerado-Mellado
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引用次数: 1

摘要

背景:芬太尼主要是一种阿片类激动剂。它经常作为一种有效的止痛药用于全身麻醉。它可以口服、经皮或全身给药。由于鸦片生物碱的不良反应通常是由于非特异性组胺释放。只有在少数情况下,可能涉及真正的过敏机制。对阿片类药物的即时反应比延迟反应更常见。在过去的几年里,由于广泛使用透皮治疗系统(TTS)和几种阿片类药物的有效镇痛特性,延迟反应的频率增加。目的:研究芬太尼TTS的延迟反应及与其他阿片类药物的交叉反应性。方法:一名诊断为胰腺癌的52岁男性患者开始使用芬太尼TTS治疗骨转移性疼痛,剂量为50微克/小时(mcg/h)。治疗10-15天后,芬太尼TTS应用部位出现瘙痒丘疹。随后,仅在贴敷部位观察到湿疹和浅表脱屑。他多次更换涂抹部位,但每次涂抹都出现同样的症状。后来,他耐受了其他阿片类药物,如口服吗啡或曲马多。进行过敏训练。我们用浓度为10%的芬太尼和浓度为10%的丁丙诺啡进行了斑贴试验(PT),以调查其他局部阿片类药物可能的交叉反应性。结果:在第2天(D2)和第4天(D4)记录读数,仅芬太尼在D2(+++)和D4(+++)时呈阳性。我们决定在TTS中使用丁丙诺啡35 mcg/h进行单盲激发试验,结果为阴性。此时,芬太尼TTS被丁丙诺啡TTS取代,耐受性良好。结论:我们报告一例因芬太尼过敏引起的过敏性接触性皮炎(ACD),对丁丙诺啡耐受性良好。该患者PT阳性提示IV型超敏反应机制。对阿片类药物的过敏反应通常是立即的,但可能出现延迟反应,特别是当药物局部施用时。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Allergic Contact Dermatitis to Fentanyl TTS with Good Tolerance to Systemic Fentanyl.

Allergic Contact Dermatitis to Fentanyl TTS with Good Tolerance to Systemic Fentanyl.

Background: Fentanyl is primarily an opioid agonist. It is frequently used in general anesthesia as a potent analgesic. It can be administered either orally, transdermally or systemically. Adverse effects due to opium alkaloids are usually because of a non-specific histamine release. Only in a few cases, a true allergy mechanism could be involved. Immediate reactions to opioids are most frequent than delayed reactions. In the past years, delayed reactions have increased in frequency because of the wide use of Transdermal Therapeutic System (TTS) with several opioids for its potent analgesic properties.

Objective: The objective was to study delayed reaction to fentanyl TTS and cross-reactivity with other opioids.

Methods: A 52-year-old man with a diagnosis of pancreatic cancer who began treatment for a bone metastases pain with fentanyl TTS, at a dose of 50 micrograms per hour (mcg/h) is the subject of the study. After 10-15 days of treatment, he developed an itchy papulovesicular rash in the application site of the fentanyl TTS. Afterward, eczema and superficial desquamation just on the application site of the patch were observed. He changed several times the site of application, but always developing the same symptoms in every single application. Later on, he tolerated other opioids such as oral morphine or tramadol. An allergy workout was performed. We performed Patch Tests (PT) with fentanyl at a concentration of 10% in aqua (aq) and with buprenorphine 10% aq., in order to investigate probable crossreactivity among other topical opioids.

Results: Readings were recorded at day 2 (D2) and day 4 (D4), with positive PT only with fentanyl at D2 (+++) and D4 (+++). We decided to perform a single-blind challenge test with buprenorphine 35 mcg/h in TTS, with a negative result. At this moment, fentanyl TTS was replaced by buprenorphine TTS, with good tolerance.

Conclusion: We present the case of Allergic Contact Dermatitis (ACD) due to hypersensitivity to fentanyl with good tolerance to buprenorphine. Positive PT in this patient suggests a type IV hypersensitivity mechanism. Allergic reactions to opioids are frequently immediate, but delayed reactions could appear, especially when the drug is administered topically.

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来源期刊
CiteScore
3.90
自引率
0.00%
发文量
0
期刊介绍: Recent Patents on Inflammation & Allergy Drug Discovery publishes review articles by experts on recent patents in the field of inflammation and allergy drug discovery e.g. on novel bioactive compounds, analogs and targets. A selection of important and recent patents in the field is also included in the journal. The journal is essential reading for all researchers involved in inflammation and allergy drug design and discovery.
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