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Allergic contact dermatitis from phenylephrine in eyedrops.
Stephan Michael Erdmann1, Bernhardt Sachs, Hans F Merk
1Department of Dermatology and Allergology, University Hospitals of RWTH Aachen, Aachen, Germany. most.erdmann@t-online.de
Summary
Allergic contact dermatitis from phenylephrine eye drops is rare. This study found no cross-reactivity between phenylephrine, epinephrine, and ephedrine in a patient with phenylephrine allergy.
Area of Science:
- Ophthalmology
- Dermatology
- Clinical Pharmacology
Background:
- Phenylephrine is a common ophthalmic drug.
- Allergic contact dermatitis from phenylephrine is infrequently reported.
- Cross-reactivity patterns among structurally similar sympathomimetics like phenylephrine, epinephrine, and ephedrine are not well-established.
Observation:
- A case of allergic contact dermatitis to phenylephrine hydrochloride in Neosynerphin POS eyedrops is presented.
- Patch testing was conducted using the ophthalmic standard series, preservatives, the eyedrop formulation, phenylephrine hydrochloride, epinephrine, and ephedrine.
- Reactions were assessed at 48, 72, and 168 hours.
Findings:
- Positive patch test reactions were observed for Neosynerphin POS and phenylephrine hydrochloride.
- Negative patch test reactions were noted for epinephrine and ephedrine.
- Delayed-type hypersensitivity to phenylephrine did not exhibit cross-reactivity with epinephrine or ephedrine, despite structural similarities.
Implications:
- This case highlights the potential for phenylephrine to cause allergic contact dermatitis.
- The findings suggest that cross-reactivity between phenylephrine and its analogs (epinephrine, ephedrine) is unlikely in the context of delayed-type hypersensitivity.
- Clinicians should consider phenylephrine as a potential allergen in ophthalmic dermatitis and be aware of the limited cross-reactivity with related sympathomimetics.