Cutaneous drug eruption induced by antihistamines

Abstract

Topical application of antihistamines commonly leads to sensitization for patients, but systemic administration of antihistamines rarely induces allergic hypersensitivity, which is mainly linked to phenothiazine-derived and piperazine-derived compounds. We report a 70-year-old woman whose medical history included lichen planus, and who was referred by the dermatology department of our hospital for suspected allergy to corticosteroids. The reason for referral was that on the fourth day of treatment with prednisone and hydroxyzine, the patient presented a bilateral highly pruritic palmar erythema that evolved to a generalized morbilliform rash with subsequent complete desquamation. At a later time, she took cetirizine for a cold, and developed palmar erythema and desquamation. Skin tests (prick and intradermal tests) were performed with steroids, and patch tests (read after 48 and 96 h) with corticosteroids and antihistamines. Controlled oral challenge tests were performed with prednisone and with an alternative antihistamine. Skin tests were negative for all corticosteroids. Patch tests were negative for all corticosteroids, but the antihistamine test was positive for hydroxyzine. Oral challenge with prednisone and dexchlorpheniramine was negative. The patient was diagnosed with cutaneous drug eruption from hydroxyzine and cetirizine. We consider it is important to assess every patient whose skin condition worsens after treatment with antihistamines, especially hydroxyzine, because it is known that antihistamines are often not recognised as the culprit in cases of cutaneous eruption.

European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology

“…Several variations have been described, according to (i) the distribution and configuration of lesions, (ii) the morphology of an individual lesion and/or (iii) the site of involvement. The various clinical forms were divided into three general categories, namely cutaneous, appendageal and mucosal lichen planus, [37][38][39][40][41][42] as well as some unclassified other forms of LP 29,[43][44][45][46][47][48][49][50][51][52][53][54] (Table 2). More information about the clinical variants, in the longer version in the EDF homepage.…”

Ultraviolet A photosensitivity profile of dexchlorpheniramine maleate and promethazine‐based creams: Anti‐inflammatory, antihistaminic, and skin barrier protection properties

“…Several case reports and studies are described in the literature on adverse reactions and even worsening of symptoms after using tAH, especially with phenothiazine‐ and piperazine‐derived compounds. Hydroxyzine and cetirizine are among the most referenced with respect the induction of sensitization or allergic reactions after topical application; however, other classes are indicated in hypersensitivity (Table ) …”

“…It was reported, in a review of the literature, that topical doxepin is the most topical preparation implicated in causing contact dermatitis . H 1 ‐Antihistamines administered orally also produce similar and generalized cutaneous reactions, such as diffuse erythema and pustules, morbilliform eruption, pruritus, toxicoderma, and exanthematous pustulosis …”

“…Hence, in addition to concomitant with antipruritic effects of antihistamines, secondary effects are expected due to the presence and function of H 1 receptors in a variety of cell types . Some have suggested mechanisms for hypersensitivity reactions caused by the oral AH such as IgE‐mediated reaction, immunoreactivity of the drug itself, and conformational changes of H 1 receptor . However, others have implicated pharmaceutical formulations and not the active compounds as direct causes for hypersensitivity .…”

Itchy papular and nodular skin lesions in chronic kidney disease patient

“…[1] The use of topical antihistamines is discouraged, as it could lead to cutaneous allergic hypersensitivity. [3] Skin infection is the most common complication of APD, in a population with known risk factors.…”