Generalized allergic contact dermatitis from nitroglycerin in a transdermal therapeutic system

Pérez-Calderón, Remedios; Gonzalo-Garijo, Ángela; Rodríguez-Nevado, Isabel

doi:10.1034/j.1600-0536.2002.460513.x

Cited by 17 publications

(6 citation statements)

References 4 publications

(5 reference statements)

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“…It obtains a better distribution of the drug through the skin, with fewer side effects if the administration is systemic [3-5]. In this line, the increasingly widespread use of opioids in TTS in order to manage intense pain, has probably increased ACD to several opioids [5]. The fentanyl transdermal patch can maintain constant fentanyl skin permeability for three days by maintaining a close contact with the skin.…”

Section: Discussionmentioning

confidence: 99%

Allergic Contact Dermatitis to Fentanyl TTS with Good Tolerance to Systemic Fentanyl

Rojas-Pérez-Ezquerra

Micozzi

Torrado-Español

et al. 2019

IAD

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Background:Fentanyl is primarily an opioid agonist. It is frequently used in general anesthe-sia as a potent analgesic. It can be administered either orally, transdermally or systemically. Adverse ef-fects due to opium alkaloids are usually because of a non-specific histamine release. Only in a few cases, a true allergy mechanism could be involved. Immediate reactions to opioids are most frequent than de-layed reactions. In the past years, delayed reactions have increased in frequency because of the wide use of Transdermal Therapeutic System (TTS) with several opioids for its potent analgesic properties.Objective:The objective was to study delayed reaction to fentanyl TTS and cross-reactivity with other opioids.Methods:A 52-year-old man with a diagnosis of pancreatic cancer who began treatment for a bone me-tastases pain with fentanyl TTS, at a dose of 50 micrograms per hour (mcg/h) is the subject of the study. After 10-15 days of treatment, he developed an itchy papulovesicular rash in the application site of the fentanyl TTS. Afterward, eczema and superficial desquamation just on the application site of the patch were observed. He changed several times the site of application, but always developing the same symp-toms in every single application. Later on, he tolerated other opioids such as oral morphine or tramadol. An allergy workout was performed. We performed Patch Tests (PT) with fentanyl at a concentration of 10% in aqua (aq) and with buprenorphine 10% aq., in order to investigate probable cross-reactivity among other topical opioids.Results:Readings were recorded at day 2 (D2) and day 4 (D4), with positive PT only with fentanyl at D2 (+++) and D4 (+++). We decided to perform a single-blind challenge test with buprenorphine 35 mcg/h in TTS, with a negative result. At this moment, fentanyl TTS was replaced by buprenorphine TTS, with good tolerance.Conclusion:We present the case of Allergic Contact Dermatitis (ACD) due to hypersensitivity to fenta-nyl with good tolerance to buprenorphine. Positive PT in this patient suggests a type IV hypersensitivity mechanism. Allergic reactions to opioids are frequently immediate, but delayed reactions could appear, especially when the drug is administered topically.

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Section: Discussionmentioning

confidence: 99%

Allergic Contact Dermatitis to Fentanyl TTS with Good Tolerance to Systemic Fentanyl

Rojas-Pérez-Ezquerra

Micozzi

Torrado-Español

et al. 2019

IAD

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“…It is reported that a Nitroderm-based allergy is rarely seen and allergic reactions can be observed on the application area or over whole body. 25,26…”

Section: Discussionmentioning

confidence: 99%

The Effect of Thrombolytic, Anticoagulant, and Vasodilator Agents on the Survival of Random Pattern Skin Flap

Aral

Tuncer

Şencan

et al. 2015

J reconstr Microsurg

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“…Clonidine was found to act as a sensitizer when applied in a clonidine TTS but not when applied in white soft paraffin (53). Allergic contact hypersensitivity to nitroglycerin is uncommon but has been recorded on several occasions (54) including a patient who developed an anaphylactic reaction (55) and another who developed a generalized skin reaction (56).…”

Section: Adverse Reactionsmentioning

confidence: 99%

Delivering drugs by the transdermal route: review and comment

Tanner¹,

Marks²

2008

Skin Research and Technology

222

112

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Background: There are many advantages to administering drugs by routes that bypass the gastrointestinal tract. One such route is the transdermal in which the drug agent is applied to the skin in a patch or device of some type so that sufficient quantity penetrates the skin to exert a systemic effect. There are several theoretical advantages to this approach not the least of which is that the drug avoids being metabolized by the liver after absorption and that gastrointestinal irritation is avoided. Aims: To discuss the various ways in which drugs can be persuaded to cross the skin barrier and also to discuss the

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Generalized allergic contact dermatitis from nitroglycerin in a transdermal therapeutic system

Cited by 17 publications

References 4 publications

Allergic Contact Dermatitis to Fentanyl TTS with Good Tolerance to Systemic Fentanyl

Allergic Contact Dermatitis to Fentanyl TTS with Good Tolerance to Systemic Fentanyl

The Effect of Thrombolytic, Anticoagulant, and Vasodilator Agents on the Survival of Random Pattern Skin Flap

Delivering drugs by the transdermal route: review and comment

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