Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case report

Abstract Background Erdosteine is used as a mucolytic agent and has a low incidence of adverse drug reactions, most of which are gastrointestinal and mild. Moreover, drug antigens rarely induce multiple simultaneous immunologic reactions. Only one previous case report has demonstrated hypersensitivi...

Full description

Bibliographic Details
Main Authors: Da Woon Sim, Ji Eun Yu, Young-Il Koh
Format: Article
Language:English
Published: BMC 2021-02-01
Series:Allergy, Asthma & Clinical Immunology
Subjects:
Online Access:https://doi.org/10.1186/s13223-021-00517-6
_version_ 1818575789026705408
author Da Woon Sim
Ji Eun Yu
Young-Il Koh
author_facet Da Woon Sim
Ji Eun Yu
Young-Il Koh
author_sort Da Woon Sim
collection DOAJ
description Abstract Background Erdosteine is used as a mucolytic agent and has a low incidence of adverse drug reactions, most of which are gastrointestinal and mild. Moreover, drug antigens rarely induce multiple simultaneous immunologic reactions. Only one previous case report has demonstrated hypersensitivity reaction induced by erdosteine. Here, we report a case of fixed drug eruption and anaphylaxis, which were concurrently induced by erdosteine. The association between the symptoms and erdosteine was proven by a drug provocation test. Case presentation A 35-year-old woman presented with recurrent angioedema and pruritic rash on the hands, which developed within 2 h following the administration of drugs, including erdosteine, for acute upper respiratory infection. Her rash was characterized by well-defined erythematous plaques, which recurred at the same site following the administration of the medications. She also experienced angioedema of the lips. Fixed drug eruption was considered after excluding other possible causes for the presented skin lesions. A drug provocation test confirmed that fixed drug eruption on both hands had occurred after administration of erdosteine, suggesting that erdosteine was the cause of the allergic reaction. However, she also experienced angioedema, isolated wheal, and laryngeal edema; thus, IgE-mediated type I hypersensitivity could also be concurrently occurring with the fixed drug eruption. Conclusions We report about a patient who was diagnosed with two different hypersensitivity reactions concurrently induced by erdosteine. We also demonstrate that patients may exhibit multiple simultaneous symptoms that usually arise from overlapping of different hypersensitivity mechanisms. Physicians should be aware of the possibility that some patients who are allergic to certain drugs could exhibit several symptoms caused by different mechanisms of hypersensitivity reactions simultaneously.
first_indexed 2024-12-15T00:45:44Z
format Article
id doaj.art-73ce379663ac4bb2825ea1ef5fb43925
institution Directory Open Access Journal
issn 1710-1492
language English
last_indexed 2024-12-15T00:45:44Z
publishDate 2021-02-01
publisher BMC
record_format Article
series Allergy, Asthma & Clinical Immunology
spelling doaj.art-73ce379663ac4bb2825ea1ef5fb439252022-12-21T22:41:32ZengBMCAllergy, Asthma & Clinical Immunology1710-14922021-02-011711510.1186/s13223-021-00517-6Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case reportDa Woon Sim0Ji Eun Yu1Young-Il Koh2Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical SchoolDivision of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical SchoolDivision of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical SchoolAbstract Background Erdosteine is used as a mucolytic agent and has a low incidence of adverse drug reactions, most of which are gastrointestinal and mild. Moreover, drug antigens rarely induce multiple simultaneous immunologic reactions. Only one previous case report has demonstrated hypersensitivity reaction induced by erdosteine. Here, we report a case of fixed drug eruption and anaphylaxis, which were concurrently induced by erdosteine. The association between the symptoms and erdosteine was proven by a drug provocation test. Case presentation A 35-year-old woman presented with recurrent angioedema and pruritic rash on the hands, which developed within 2 h following the administration of drugs, including erdosteine, for acute upper respiratory infection. Her rash was characterized by well-defined erythematous plaques, which recurred at the same site following the administration of the medications. She also experienced angioedema of the lips. Fixed drug eruption was considered after excluding other possible causes for the presented skin lesions. A drug provocation test confirmed that fixed drug eruption on both hands had occurred after administration of erdosteine, suggesting that erdosteine was the cause of the allergic reaction. However, she also experienced angioedema, isolated wheal, and laryngeal edema; thus, IgE-mediated type I hypersensitivity could also be concurrently occurring with the fixed drug eruption. Conclusions We report about a patient who was diagnosed with two different hypersensitivity reactions concurrently induced by erdosteine. We also demonstrate that patients may exhibit multiple simultaneous symptoms that usually arise from overlapping of different hypersensitivity mechanisms. Physicians should be aware of the possibility that some patients who are allergic to certain drugs could exhibit several symptoms caused by different mechanisms of hypersensitivity reactions simultaneously.https://doi.org/10.1186/s13223-021-00517-6AnaphylaxisErdosteineFixed drug eruptionHypersensitivity reactionSimultaneous drug reaction
spellingShingle Da Woon Sim
Ji Eun Yu
Young-Il Koh
Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case report
Allergy, Asthma & Clinical Immunology
Anaphylaxis
Erdosteine
Fixed drug eruption
Hypersensitivity reaction
Simultaneous drug reaction
title Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case report
title_full Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case report
title_fullStr Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case report
title_full_unstemmed Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case report
title_short Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case report
title_sort fixed drug eruption and anaphylaxis induced concurrently by erdosteine a case report
topic Anaphylaxis
Erdosteine
Fixed drug eruption
Hypersensitivity reaction
Simultaneous drug reaction
url https://doi.org/10.1186/s13223-021-00517-6
work_keys_str_mv AT dawoonsim fixeddrugeruptionandanaphylaxisinducedconcurrentlybyerdosteineacasereport
AT jieunyu fixeddrugeruptionandanaphylaxisinducedconcurrentlybyerdosteineacasereport
AT youngilkoh fixeddrugeruptionandanaphylaxisinducedconcurrentlybyerdosteineacasereport