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Urticaria induced by antihistamines.

D González de Olano1, J Roán Roán, B de la Hoz Caballer

  • 1Allergy Department; Hospital Ramón y Cajal, Madrid, Spain. david@gonzalezolano.com

Journal of Investigational Allergology & Clinical Immunology
|May 13, 2006
PubMed
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Antihistamines, commonly used for allergies, can paradoxically cause urticaria (hives). This case study highlights a patient experiencing hives from multiple antihistamine classes, challenging their typical mechanism of action.

Area of Science:

  • Pharmacology
  • Allergology
  • Immunology

Background:

  • H1-antihistamines are primary treatments for allergic diseases, acting as inverse agonists at H1 receptor sites.
  • Adverse effects from antihistamines are known, with skin reactions being exceptionally rare.
  • The precise mechanism of antihistamine-induced hypersensitivity remains incompletely understood.

Purpose of the Study:

  • To report a unique case of recurrent urticaria triggered by structurally diverse H1-antihistamines.
  • To investigate the patient's sensitization to antihistamines using skin prick tests (SPT) and oral challenges.
  • To explore potential alternative mechanisms for antihistamine-induced adverse reactions.

Main Methods:

  • The study involved a patient with multiple episodes of urticaria attributed to different antihistamine families (piperazines and piperidines).

Related Experiment Videos

  • Diagnostic procedures included skin prick tests (SPT), patch tests, and carefully controlled oral challenges with various antihistamines.
  • Histamine H1 receptor pharmacology and potential conformational changes were considered in the investigation.

    • Main Results:

    • The patient exhibited positive SPT to certain antihistamines and positive oral challenges to others, despite negative SPT results for those.
    • Despite extensive testing, the exact route of sensitization to antihistamines could not be definitively determined.
    • The patient ultimately demonstrated intolerance to all tested antihistamines following oral challenges.

    Conclusions:

    • This case presents the first report of urticaria induced by multiple antihistamine classes in a single patient, with varied SPT results.
    • The findings challenge the conventional understanding of H1-antihistamine inverse agonism, suggesting they might activate rather than inactivate the H1 receptor in some individuals.
    • Further research is warranted to elucidate the complex mechanisms underlying antihistamine-induced hypersensitivity reactions and guide safer therapeutic strategies.