Recurrent fixed drug eruption due to metronidazole elicited by patch test with tinidazole

Prieto, A.; Barrio, M. De; Infante, Sonsoles; Torres, Ana; Rubio, M.; Olalde, S.

doi:10.1111/j.0105-1873.2005.0407a.x

Cited by 13 publications

(8 citation statements)

References 9 publications

(17 reference statements)

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“…It is also the first one in which an in vitro diagnostic test was used, such as LTT. Thus far, there was only record of cross-reactivity between Bzn and metronidazole (Prieto et al, 2005; Pérez-Molina et al, 2013; Noguerado-Mellado et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Lymphocyte Transformation Test (LTT) in Allergy to Benznidazole: A Promising Approach

et al. 2019

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Benznidazole (Bzn) from the nitroimidazole family and nifurtimox from nitrofurans family, are drugs used as first and second line treatment for acute and chronic phases of Chagas disease (CD). Even though skin reactions are frequent, confirmed allergy to Bzn is rare, and there are few cases reported in the literature. Since CD treatment is very restrained, the possibility of cross-reactivity between members of the same and other pharmacological families highlights the importance of an adequate diagnosis that allows alternative treatments in CD and other diseases. We report a series of 31 patients (69% women) referred to our Allergy unit with suspected hypersensitivity to Bzn, twenty three of them with mild reactions and eight of them with severe reactions. LTT with Bzn was performed in 31 patients and in 8 negative controls. LTT was also performed in 25 and 20 of these patients with nifurtimox and Mtn, respectively. Twenty-one out of thirty-one patients were Bzn prick tested, and all were negative. We obtained 2/19 positive results on patch tests to Bzn. LTT with Bzn was positive in 22/31 patients (Sensitivity 75.9% and specificity 100%). The test was considered positive with a stimulation index ≥2. There was a positive result in 7/25 patients for nifurtimox and in 7/20 patients with Mtn. After negative LTT and skin tests, oral provocation was performed in 4/9 patients, all negative. LTT is a safe test that seems to be more useful than skin tests (prick and patch test), particularly in severe reactions, in confirming delayed hypersensitivity to Bzn and detecting cross reactivity with other imidazoles such as Mtn and reactivity to other drugs like nifurtimox. Tests for these drugs need to be included in the workup of patients with hypersensitivity to Bzn in case they are needed as an alternative treatment for CD or to treat other frequent infectious diseases.

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Section: Introductionmentioning

confidence: 99%

Lymphocyte Transformation Test (LTT) in Allergy to Benznidazole: A Promising Approach

et al. 2019

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“…Metronidazole used as a topical agent is generally well tolerated, and contact dermatitis to topically applied metronidazole is rare and only two cases have been published previously (1, 2). There have been isolated reports of immediate allergic reactions and urticaria (3–5), fixed drug eruptions (6–13) and acute generalized exanthematous pustulosis (14) due to topical metronidazole. Vincenzi et al (1) investigated their patient for possible cross reactions to other imidazole derivatives, but did not find any, in accordance with our finding in case III.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Allergic contact dermatitis to topical metronidazole – 3 cases

Thormann

Kerre²,

Andersen

et al. 2007

Contact Dermatitis

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“…Other Hypersensitivity Reactions Other case reports include allergic contact dermatitis [75], fixed drug eruption [76][77][78][79], serum sickness-like reaction [80], SJS/TEN [81,82], AGEP [83,84], SDRIFE [85], and a possible case of DRESS given fever and rash but no lab studies were done to assess internal organ involvement [86].…”

Section: Ige-mediated Reactionsmentioning

confidence: 99%

Immediate and Delayed Hypersensitivity Reactions to Antibiotics: Aminoglycosides, Clindamycin, Linezolid, and Metronidazole

Dilley

Geng

2021

Clinic Rev Allerg Immunol

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Hypersensitivity reactions including IgE-mediated and delayed cell-mediated reactions to aminoglycosides, clindamycin, linezolid, and metronidazole are rare. For aminoglycosides, allergic contact dermatitis is the most frequent reaction for which patch testing can be a useful step in evaluation. For clindamycin, delayed maculopapular exanthems are the most common reactions. There are case reports of clindamycin associated with drug rash with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), acute febrile neutrophilic dermatosis, and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). For linezolid, cases of hypersensitivity were exceedingly rare and included urticaria, angioedema, anaphylaxis, delayed rashes, and DRESS. For metronidazole, only rare cases were found across a broad spectrum of reactions including allergic contact dermatitis, fixed drug eruption, angioedema, anaphylaxis, serum sickness-like reaction, SJS/TEN, AGEP, SDRIFE, and a possible case of DRESS. IgE-mediated reactions and anaphylaxis to these types of antibiotics are uncommon, and reports of skin testing concentrations and desensitization protocols are largely limited to case reports and series. Non-irritating skin testing concentrations have been reported for gentamycin, tobramycin, and clindamycin. Published desensitization protocols for intravenous and inhaled tobramycin, oral clindamycin, intravenous linezolid, and oral and intravenous metronidazole have also been reported and are reviewed.

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Recurrent fixed drug eruption due to metronidazole elicited by patch test with tinidazole

Cited by 13 publications

References 9 publications

Lymphocyte Transformation Test (LTT) in Allergy to Benznidazole: A Promising Approach

Lymphocyte Transformation Test (LTT) in Allergy to Benznidazole: A Promising Approach

Allergic contact dermatitis to topical metronidazole – 3 cases

Immediate and Delayed Hypersensitivity Reactions to Antibiotics: Aminoglycosides, Clindamycin, Linezolid, and Metronidazole

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