Prasugrel hypersensitivity with respiratory distress and rash

Area of Science:

• Cardiology
• Pharmacology
• Allergy and Immunology

Background:

• Dual antiplatelet therapy (DAPT) with P2Y12 inhibitors is crucial after percutaneous coronary intervention (PCI) with stent placement.
• Prasugrel, a thienopyridine P2Y12 inhibitor, is commonly used for DAPT.
• Hypersensitivity reactions to antiplatelet agents can complicate post-PCI management.

Observation:

• A 61-year-old woman developed acute respiratory distress, throat tightness, and a widespread pruritic rash approximately 24 hours after initiating prasugrel therapy.
• The patient had undergone angioplasty and stent revision prior to prasugrel initiation.
• Symptoms rapidly improved following administration of epinephrine, diphenhydramine, and methylprednisolone.

Findings:

• Discontinuation of prasugrel led to the resolution of hypersensitivity symptoms.
• Naranjo scale analysis indicated prasugrel as the probable cause of the hypersensitivity reaction.
• Switching to ticagrelor, a non-thienopyridine P2Y12 inhibitor, allowed for safe continuation of DAPT.

Implications:

• This case highlights a potential hypersensitivity reaction to prasugrel in patients undergoing PCI.
• Ticagrelor serves as a viable alternative for DAPT in patients with suspected or confirmed thienopyridine allergy.
• Consideration of desensitization protocols or alternative P2Y12 inhibitors is important for managing prasugrel-induced hypersensitivity.