R García Rodríguez | PubMed Health

PubMedDate not supplied

Drug fever attributable to Calcium Dobesilate.

Many drugs may cause fever through different mechanisms, the most frequent being hypersensitivity. We are reporting on two cases of drug fever attributable to Calcium Dobesilate, a drug used for treating chronic venous insufficiency and other vascular disturbances. The diagnosis was made by oral challenge with the drug. It reproduced the clinical picture referred to in the anamnesis, including hyperthermia. In patient 2 the challenge proved to be useful though she was being treated with oral corticosteroids for systemic lupus erythematosus (SLE). Cutaneous tests (PRICK and patch tests) were negative with the suspected drug; however we think that an immunological mechanism could be responsible for the reactions.

Calcium Dobesilate↗

PubMedDate not supplied

Phenytoin hypersensitivity syndrome with positive patch test. A possible cross-reactivity with amitriptyline.

A 34-year-old woman, after 2 weeks of treatment with phenytoin and amitriptyline, developed fever and cutaneous lesions consisting of a generalized maculopapular rash and eosinophilia. Her biochemical data showed abnormal liver functions with increased levels of SGOT, SGPT, LDH, gamma-glutamyl transpeptidase and alkaline phosphatase. The skin biopsy pattern was compatible with phenytoin drug eruption of the erythemamultiforme-like type (lymphocytic exocytosis, isolated dyskeratotic cells, vacuolation of basal cells and incontinence of pigment). The patch tests were positive with phenytoin (patch test biopsy showed a typical eczematous pattern). The patch test with amitriptyline was negative. An oral challenge with amitriptyline showed an erythematous maculopapular rash. The challenge with phenytoin was not carried out because the previously abnormal liver function tests contraindicated the challenge. Although there are a few cases reported, the patch tests could be useful for diagnosing phenytoin allergy. Cross-reactivity between phenytoin and amitriptyline is possible.

Administration, Oral↗

PubMedDate not supplied

Hypersensitivity to chironomid larvae.

Chironomid larvae (red midge larvae) are often used by aquarists as fish food. Their hemoglobins can cause IgE-mediated allergic diseases in exposed and unexposed people. The aim of this study was to find out the prevalence of positive skin tests to chironomids in patients suffering from rhinitis and/or bronchial asthma in Ciudad Real (Spain). A total of 465 patients were submitted to skin prick tests with chironomids in addition to common inhalant allergens. The patients with positive skin prick test (wheal > or = 3 mm) to these larvae answered a questionnaire. Skin prick tests with Acarus siro, shrimp, cockroach and mosquito (Culex pipiens) were carried out. Serum levels of total IgE and anti-Chironommus thummi, anti-Dermatophagoides pteronyssinus, anti-shrimp, and anti-mosquito (Aedes communis) IgE were determined. Conjunctival or nasal provocation tests were carried out with chironomids. Of the 465 patients skin tested, 19 showed a positive skin prick test with chironomids, corresponding to 4.1% of all patients and 6% of the atopic patients. None were monosensitized. Significant correlations were found between skin prick test results with chironomids and mites (p < 0.005). Of the 19 patients, 15 had positive skin prick test with the common mosquito C. pipiens. Seven patients showed elevated anti-D. pteronyssinus IgE, six elevated anti-shrimp IgE, and 10 showed elevated anti-A. communis IgE. Provocation tests with chironomids were positive in 14 patients (four nasal and 10 conjunctival tests). Conjunctival provocation tests were carried out in 16 controls and were positive in three; all three showed positive skin prick test with chironomids. One patient had occupational allergy from the larvae (aquarist). After mosquito bites, five patients showed immediate wheal reactions and one patient suffered an anaphylactic reaction after several mosquito bites. Only two patients remembered having been in contact with chironomids as fish food. We found hypersensitivity to these larvae in patients without apparent contact to them. These patients could have become sensitized in various ways, including: 1) inhaling particles of chironomids or others that are cross-reactive with them; 2) exposure to products used as fish food containing chironomids; and, 3) through cross-reactivity with other allergens such as mites, shrimp or mosquitoes.

Adolescent↗