Generalized dermatitis due to codeine. Cross‐sensitization among opium alkaloids

Rodríguez, A.; Barranco, Ruth; Latasa, Margarita; Urbina, Juan; Estrada, J. L.

doi:10.1111/j.0105-1873.2005.0670h.x

Cited by 18 publications

(16 citation statements)

References 4 publications

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“…This made avoidance of the allergen in the workplace difficult, and, in a number of cases, workers had to leave their employment because of ongoing ACD. Many of the cases reported in the literature haved described cross‐reactions between different opioids within the same class . Our data show that, of 11 patients with ACD, six reacted to at least two substances.…”

Section: Discussionmentioning

confidence: 54%

Occupational contact dermatitis caused by opioids: A case series

2019

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Background: Opioid-manufacturing facility workers are at risk of developing occupational contact dermatitis.Objectives: To describe the causes of occupational allergic contact dermatitis caused by opioids in an opioid-manufacturing facility. Materials and Methods:A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne, Australia from 2004 to 2017.Results: Fifteen workers from an opioid-manufacturing facility were assessed in our clinic over a period of 14 years. Of these, 11 individuals were diagnosed with occupational allergic contact dermatitis caused by opioids, with seven reacting to thebaine, five to morphine, four to norhydroxymorphinone, two to codeine, and two to oripavine. Two people were suspected of having immediate hypersensitivity reactions to opioids, including one who also had allergic contact dermatitis. Two patients were diagnosed with urticaria, aggravated at work. One patient was diagnosed with a non-occupational rash. Conclusions:We report a case series of workers with allergic contact dermatitis caused by opioids in a manufacturing facility. With greater awareness, including implementation of an educational programme and improved skin protection, the number of cases declined over time. Interestingly, norhydroxymorphinone had not been reported as an allergen before. Further testing is required to establish optimal patch test concentrations of all opiates. K E Y W O R D Scontact allergy, occupational allergic contact dermatitis, opioids, opioid-manufacturing facility, patch test, urticaria

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Section: Discussionmentioning

confidence: 54%

Occupational contact dermatitis caused by opioids: A case series

2019

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“…Previously, cross-reaction in patch tests has been reported between codeine, morphine and diacetylmorphine [9,10]. After contact allergy to buprenorphine had been confirmed, our patient 1 was treated with codeine only with no flare-ups of allergic contact dermatitis.…”

Section: Discussionmentioning

confidence: 75%

Allergic Contact Dermatitis from Buprenorphine and Oral Tolerance to Other Opioid Derivatives in Three Patients

et al. 2013

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Transdermal buprenorphine (TDB) is a widely used analgesic for moderate pain. TDB is generally well tolerated, but both irritant and allergic contact dermatitis occur at patch application sites. Oral opioid tolerance in patients with allergic contact dermatitis to TDB remains controversial. Here, we describe 3 patients with allergic contact dermatitis to TDB who subsequently used oral opioid derivatives without adverse reactions. Thus, oral intolerance to opioid derivatives is not a rule in patients with allergic contact dermatitis to TDB, but the possibility should be taken into consideration.

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“…Previous studies have suggested that cutaneous allergic reactions to codeine can be induced by the non-immunological induction of histamine release 3,7,8. There have been even rarer hypersensitivity reactions to codeine, including generalized maculopapular eruptions, bullous eruptions, fixed drug eruptions, drug-induced hypersensitivity syndrome, or even toxic epidermal necrolysis 2,9-13. In this study, we confirmed anaphylaxis by OPT.…”

Section: Discussionmentioning

confidence: 99%

A Case of Codeine Induced Anaphylaxis via Oral Route

Yoo

Yang

Kim

et al. 2014

Allergy Asthma Immunol Res

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Codeine is widely prescribed in clinical settings for the relief of pain and non-productive coughs. Common adverse drug reactions to codeine include constipation, euphoria, nausea, and drowsiness. However, there have been few reports of serious adverse reactions after codeine ingestion in adults. Here, we present a case of severe anaphylaxis after oral ingestion of a therapeutic dose of codeine. A 30-year-old Korean woman complained of the sudden onset of dyspnea, urticaria, chest tightness, and dizziness 10 minutes after taking a 10-mg dose of codeine to treat a chronic cough following a viral infection. She had previously experienced episodes of asthma exacerbation following upper respiratory infections, and had non-atopic rhinitis and a food allergy to seafood. A skin prick test showed a positive response to 1-10 mg/mL of codeine extract, with a mean wheal size of 3.5 mm, while negative results were obtained in 3 healthy adult controls. A basophil histamine release test showed a notable dose-dependent increase in histamine following serial incubations with codeine phosphate, while there were minimal changes in the healthy controls. Following a CYP2D6 genotype analysis, the patient was found to have the CYP2D6*1/*10 allele, indicating she was an intermediate metabolizer. An open label oral challenge test was positive. To the best of our knowledge, this is the first report of a patient presenting with severe anaphylaxis after the ingestion of a therapeutic dose of codeine, which may be mediated by the direct release of histamine by basophils following exposure to codeine.

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Generalized dermatitis due to codeine. Cross‐sensitization among opium alkaloids

Abstract: Opium alkaloids can cause immunological reactions. Cross-sensitization among them must be considered in these situations.

Cited by 18 publications

References 4 publications

Occupational contact dermatitis caused by opioids: A case series

Occupational contact dermatitis caused by opioids: A case series

Allergic Contact Dermatitis from Buprenorphine and Oral Tolerance to Other Opioid Derivatives in Three Patients

A Case of Codeine Induced Anaphylaxis via Oral Route

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