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Drug eruption by antihistamine mistaken for chronic urticaria in a child
Gun Moo Lee1, Shou-Yu Chu2, Sung Yeon Kang1
1Department of Pediatrics, Kangwon National University Hospital, chuncheon, Korea.
Insights
Antihistamines can cause rare adverse reactions like skin eruptions in children. This case report shows cross-reactivity between different antihistamines, a phenomenon also seen in adults.
Area of Science:
- Pediatric Allergy and Immunology
- Dermatology
- Clinical Pharmacology
Background:
- Antihistamines are commonly used for allergic conditions.
- Adverse drug reactions to antihistamines, though rare, can include skin eruptions and anaphylaxis.
- Pediatric patients may exhibit similar adverse reactions to medications as adults.
Purpose of the Study:
- To investigate the causal relationship between antihistamine administration and drug-induced skin eruptions in a pediatric patient.
- To evaluate potential cross-reactivity between different antihistamines in a child presenting with adverse reactions.
- To highlight the occurrence of antihistamine-induced adverse effects in children.
Main Methods:
- A case report of a 4-year-old child experiencing skin eruptions post-antihistamine use.
- Diagnostic procedures included skin prick tests, intradermal tests, and oral drug provocation tests.
- Specific antihistamines evaluated were levocetirizine and ketotifen.
Main Results:
- Levocetirizine induced wheals during skin prick testing and a rash upon oral provocation.
- Ketotifen did not elicit a reaction in skin prick tests but resulted in a positive reaction during oral provocation.
- The patient experienced skin eruptions attributed to antihistamine administration.
Conclusions:
- Children can experience similar adverse reactions to antihistamines as adults.
- Cross-reactivity between different antihistamines is possible and can manifest as drug-induced eruptions.
- Diagnostic testing is crucial for identifying specific drug triggers and potential cross-reactivity in pediatric patients.
Abstract:
Although rare, antihistamines can cause adverse effects, including drug-induced eruptions or anaphylaxis. A 4-year-old child visited the pediatric department of a hospital for skin eruptions after administration of antihistamines, (e.g., ucerax [hydroxyzine] or leptizine [levocetirizine]), for cholinergic rashes; he did not have pruritus. Skin prick, intradermal, and drug provocation tests were performed to determine the relationship between the antihistamines and eruptions. Levocetirizine induced wheals in the skin prick test and a rash in the oral drug provocation test. In contrast, ketotifen induced no reaction in the skin prick test but showed a positive reaction in the oral provocation test. Our case report highlights that children can experience the same types of adverse reactions as seen in adults, and cross-reactivity between various antihistamines can occur.
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