Skin reactions to hydroxyzine

Abstract

Sensitivity to histamine H1-antagonists has mainly been observed with phenothiazine and ethylenediamine, and is very rare with hydroxyzine. We report 3 cases of sensitization to hydroxyzine, which was prescribed to treat urticaria and atopic dermatitis. A generalized maculopapular eruption appeared shortly after taking the drug. Patch tests with Atarax tablet were positive +3, and +2 or +3 with different dilutions of hydroxyzine. Patch tests with ethylenediamine, piperazine and other antihistamines were negative; therefore, there is no cross-allergy. We believe these rapid systemic reactions to hydroxyzine after the initial dose may have been due to prior systemic sensitivity to this drug, which cannot be used topically. Allergy to antihistamines must be considered when cutaneous lesions worsen on such therapy.

Drug patch testing in systemic cutaneous drug allergy

“…The most frequent reports of positive drug patch tests are related to the following drugs: betalactam antibiotics (Romano et al, 2002), especially amoxicillin (Barbaud et al, 1998b(Barbaud et al, , 2000Van Ketel, 1987, 1989;Bruynzeel et al, 1985;Romano et al, 1993Romano et al, , 1995Barbaud et al, 1997;Vega et al, 1991;Felix and Comaish, 1974), cotrimoxazole (Klein et al, 1995), corticosteroids (Barbaud et al, 1998b;Dooms-Goossens, 1995;Bircher et al, 1996;Kilpio and Hannuksela, 2003), heparin derivatives (Barbaud et al, 1998b;Bircher et al, 1990;Moreau et al, 1996;Figarella et al, 2001), pristinamycin (Barbaud et al, 1998bMichel et al, 1996), carbamazepine (Barbaud et al, 1998b(Barbaud et al, , 2000Vaillant et al, 1989;Silva et al, 1982;Camarasa, 1985;Romaguera et al, 1989;Jones et al, 1994;Rodriguez-Mosquera et al, 1991;Alanko, 1993;Corazza et al, 1995;Puig et al, 1996), diltiazem (Barbaud et al, 1998a(Barbaud et al, , 1993Romano et al, 1992;Cholez et al, 2003), hydroxyzine (Barbaud et al, 1998b;Michel et al, 1997), pseudoephedrine …”

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions

“…The most frequent reports of positive drug patch tests are related to the following drugs: betalactam antibiotics, especially amoxicillin (1,2,4,6,18,(24)(25)(26)(27)(28)(29)(30), cotrimoxazole (15), corticosteroids (1,31,32), heparin derivatives (1,(33)(34)(35)(36), pristinamycin (1,36), carbamazepine (1,2,20,(37)(38)(39)(40)(41)(42)(43)(44), diltiazem (1,45,46), diazepam (47), hydroxyzine (1,48), pseudoephedrine (1,21,22) and tetrazepam (1,16,(49)(50)(51).…”

Cutaneous drug eruption from cetirizine and hydroxyzine

“…[8][9][10][11][12][13][14][15][16][17][18][19][20] According to the reports, drug eruption from cetirizine, unlike eruptions from hydroxyzine and other drugs, is usually in the form of urticaria. Because of that, it is sometimes misinterpreted as urticaria that fails to respond to antihistamines.…”