羟嗪诱导的固定性药疹和与恶托明的交叉反应

IF 1.1 Q4 ALLERGY
Mizuki Terada MD, Shujiro Hayashi MD, PhD, Maki Okamoto MD, Ken Igawa MD, PhD
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引用次数: 0

摘要

诱发药物。病变部位PT是一种有效的诊断手段。然而,很少有报道表明这些药物与FDE的发展有关,特别是哌嗪衍生物,如羟嗪、西替利嗪和左西替利嗪。1 Bhari等人4报道了一例对含有哌嗪环的药物过敏的患者,该患者对另外两种含有哌嗪环的药物出现交叉反应。目前还没有关于氧肟胺与羟嗪交叉反应的报道;然而,两者都具有哌嗪环结构(图1E、F中的红色圆圈)。因此,交叉反应性可能出现。在这种情况下,尽管eszopiclone有一个哌嗪环(图1G),但迄今为止没有爆发的报道。因此,在我们的案例中,抗原决定因素不是哌嗪环。Oxatomide和羟嗪不仅共享一个哌嗪环,而且通过一个甲基(= CH -;图1E、F中的绿色方格)。这一共有的结构基团被认为是抗原决定因素,并导致交叉反应。据我们所知,这样一个独特的病例还没有报道过,在这个病例中提出了一种新的与FDE相关的抗原结构群的可能性,这需要进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Hydroxyzine-induced fixed drug eruption and cross-reaction with oxatomide

Hydroxyzine-induced fixed drug eruption and cross-reaction with oxatomide

Oxatomide and hydroxyzine are two anti-H1 antihistamines used for treating urticaria, pruritus dermatitis, pollinosis, and several other diseases. In general, anti-H1 antihistamines rarely elicit cutaneous adverse effects.1 We report a case of fixed drug eruption (FDE) caused by the cross-reaction between oxatomide and hydroxyzine.

A 50-year-old woman had a history of taking oxatomide for seasonal pollinosis. She took oxatomide in the first season of 2002. Painful erythema and erosions appeared 5 h after taking the drug. These symptoms appeared on the lower lip and at the mucocutaneous junction (Figure 1A), with positive results in the patch test (PT; Figure 1B) for oxatomide and oral challenge test. The same skin lesion appeared 5 h after taking oxatomide; these results led to the diagnosis of oxatomide-induced FDE. This eruption improved after the discontinuation of oxatomide and administration of prednisolone (PSL) at 0.6 mg/kg/day for 1 week.

We previously reported and published the above-mentioned case until this clinical point.2 Although she took eszopiclone and bepotastine besilate for insomnia because of pollinosis, no drug eruption appeared. One year later, she took hydroxyzine for the first time for sleeplessness because of pollinosis. On the next morning, she had fever and subsequently experienced lip discomfort. Furthermore, on the next day, erythema, blisters, and erosions appeared around the lower lip (Figure 1C). These eruptions were almost similar to the previously described oxatomide-induced FDE. PT against hydroxyzine revealed positive results, and the patient was diagnosed with hydroxyzine-induced FDE (Figure 1D). The eruptions improved using the same treatment that was used for oxatomide-induced eruptions. Moreover, pollinosis-associated insomnia improved using eszopiclone and did not cause any skin eruptions.

FDE is a clinical form of drug eruption that induces erythema in the same region of the body after each administration of the causative drug. PT at the lesion is an effective means for diagnosis.3 However, few reports have implicated such drugs in the development of FDE, particularly the piperazine derivatives, such as hydroxyzine, cetirizine, and levocetirizine.1 Bhari et al.4 reported the case of a patient with an allergy to a drug containing a piperazine ring, who presented a cross-reaction to two other drugs containing piperazine rings. There are no reports on the cross-reactivity between oxatomide and hydroxyzine; however, both share a piperazine ring structure (red circles in Figure 1E,F). Thus, cross-reactivity could appear. In this case, although eszopiclone has a piperazine ring (Figure 1G), no eruption has been reported to date. Therefore, the antigenic determinant in our case was not a piperazine ring. Oxatomide and hydroxyzine share not only a piperazine ring but also two benzene rings via a methine group (=CH–; green square in Figure 1E,F). This shared structural group was suggested to become an antigenic determinant and results in cross-reactivity. To the best of our knowledge, such a unique case has not yet been reported, and the possibility of a novel antigenic structural group associated with FDE is proposed in this case, which needs further investigations.

The authors declare no conflicts of interest.

Approval of the research protocol: No human participant was involved in this study.

Informed Consent: Informed consent was obtained from the patient.

Registry and the Registration No. of the study/trial: N/A. Animal Studies: N/A.

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