Is oral isotretinoin treatment contraindicated for patients with known peanut allergies?

Humphrey, Victoria; Phillips, S M; James, William D.

doi:10.1016/j.jdcr.2019.02.016

Cited by 2 publications

(1 citation statement)

References 2 publications

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“…In line with the manufacturers instructions, the literature review did not identify any published cases of soybean allergic patients treated with isotretinoin. However, various publications suggest that a vast majority of peanut and tree nut sensitized patients, even those with clinically manifest allergy, benefit from isotretinoin therapy without experiencing allergic reactions (Table 1 ) [ 2 , 6 , 7 , 15 – 19 ]. There were no publications describing prescription of isotretinoin specifically in birch pollen allergic patients.…”

Section: Discussionmentioning

confidence: 99%

Isotretinoin-associated exercise-induced anaphylaxis in a patient with birch pollinosis and soybean sensitization: case presentation and literature review

Bamidis

Hofmann

2021

Allergy Asthma Clin Immunol

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Background Peanut and soybean allergies are listed as contraindication in the package leaflet of isotretinoin, a widely used treatment of acne vulgaris. Cross-reactivity between PR10-proteins in peanut, tree nuts, and soybean is particularly common in patients with birch pollinosis and may lead to anaphylactic reactions in sensitized patients after intake of soybean oil containing isotretinoin capsules. Case presentation Here, we describe a young man with hazelnut and birch pollen allergy, who experienced exercise-induced anaphylaxis after isotretinoin intake on the third day of treatment. A complete allergy work-up was carried out, and sensitization to both peanut and soybean PR10-proteins was confirmed. However, oral provocation with isotretinoin remained negative in the absence of intense physical activity and longterm treatment was well tolerated. Conclusion To our knowledge, this is the first report of an exercise-induced anaphylaxis due to isotretinoin therapy. Our literature review to assess tolerability of isotretinoin in patients allergic to peanut, tree nuts or soybean revealed only one other case of anaphylaxis in a cashew-nut allergic patient sensitized to soybean PR10-protein Gly m 4. While there are no reports on soybean allergic patients treated with isotretinoin, the vast majority of peanut or tree nut allergic patients tolerated isotretinoin. Therefore, we conclude that sensitization to soybean, peanut or tree nuts should not preclude isotretinoin therapy. Particular caution is however warranted in patients with soybean sensitization. Pre-treatment oral challenges with isotretinoin may be recommended and physicians should be aware of the potential role of cofactors.

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Section: Discussionmentioning

confidence: 99%

Isotretinoin-associated exercise-induced anaphylaxis in a patient with birch pollinosis and soybean sensitization: case presentation and literature review

Bamidis

Hofmann

2021

Allergy Asthma Clin Immunol

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A systematic review of isotretinoin and its contraindications in peanut, soybean and cashew nut allergies

Hussaini,

Bakir

et al. 2024

JEADV Clinical Practice

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Should oral isotretinoin be considered contraindicated in patients with peanut, soybean, and cashew allergies? A systematic literature search of PubMed, EMBASE and The Cochrane Library up to July 2023 was conducted to identify randomised control trials (RCTs), cohort studies, case reports, and cross‐sectional studies investigating if isotretinoin should be contraindicated in patients with various allergies including peanut, soybean, and cashew allergies. Primary outcomes explored included relapse, adverse effects, and safety profiles of oral isotretinoin at varying doses. Secondary outcomes included efficacy as well as economic considerations. The quality of studies, including risk of bias, was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). A total of eight studies were included. The majority of studies suggested that isotretinoin should not be considered inadvisable. In cases with peanut allergies, minimal adverse effects were noted with various dosages of isotretinoin and prolonged treatment duration. In cases with soybean allergies, similar results and conclusions were obtained to the cases with peanut allergies, however the number of studies were not of similar value to those of peanut allergies. Comparison between studies was challenging due to differing methods of assessment, subjective interpretation of severity and duration of follow‐up. This review highlights the need for an adequately powered RCT, to decipher whether isotretinoin should not be given to patients with peanut, soybean or cashew allergies.

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Is oral isotretinoin treatment contraindicated for patients with known peanut allergies?

Cited by 2 publications

References 2 publications

Isotretinoin-associated exercise-induced anaphylaxis in a patient with birch pollinosis and soybean sensitization: case presentation and literature review

Isotretinoin-associated exercise-induced anaphylaxis in a patient with birch pollinosis and soybean sensitization: case presentation and literature review

A systematic review of isotretinoin and its contraindications in peanut, soybean and cashew nut allergies

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