Advertisement

American Journal of Clinical Dermatology

, Volume 2, Issue 3, pp 151–158 | Cite as

Drug-Induced Urticaria

Recognition and Treatment
Review Article

Abstract

Urticaria is the second most common cutaneous manifestation of drug allergy. Drug-induced urticaria is seen in 0.16% of medical inpatients and accounts for 9% of chronic urticaria or angioedema seen in dermatology outpatient departments. Occurring within 24 hours of drug ingestion, it is most commonly caused by penicillins, sulfonamides and nonsteroidal anti-inflammatory drugs.

Drug-induced urticaria is seen in association with anaphylaxis, angioedema, and serum sickness. Diagnosis requires a detailed history, knowledge of the most likely agents sometimes supplemented with in vitro and skin testing. For mild reactions, avoidance of the causative drug and treatment with antihistamines will suffice. For anaphylactic shock, treatment with epinephrine (adrenaline), corticosteroids and antihistamines is required. Patients should be educated to inform medical staff about previous drug reactions, and to avoid these and cross-reacting drugs if possible. Medical staff need to routinely enquire about allergy and avoid unnecessary prescriptions.

Keywords

Urticaria Histamine Release Angioedema Tryptase Loratadine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Sharma V.K., Kaur I., Vatve M., et al. Rifampicin-induced urticaria in leprosy. Leprosy Rev 1997; 68 (4): 331–332PubMedGoogle Scholar
  2. 2.
    Gupta A.K., Lynde C.W., Lauzon G.J., et al. Cutaneous adverse effects associated with terbinafine therapy: 10 case reports and a review of the literature]. Br J Dermatol 1998; 138 (3): 529–532PubMedCrossRefGoogle Scholar
  3. 3.
    Demoly P., Messaad D., Trylesinski A., et al. Nelfinavir-induced urticaria and successful desensitization. J Allergy Clin Immunol 1998; 102 (5): 875–876PubMedCrossRefGoogle Scholar
  4. 4.
    Kainer M.A., Mijch A. Anaphylactoid reaction, angioedema, and urticaria associated with lamivudine. Lancet 1996; 348 (9040): 1519PubMedCrossRefGoogle Scholar
  5. 5.
    Demoly P., Messaad D., Fabre J., et al. Nevirapine-induced cutaneous hypersensitivity reactions and successful tolerance induction. J Allergy Clin Immunol 1999; 104 (2 Pt 1): 504–505PubMedCrossRefGoogle Scholar
  6. 6.
    Smith H.R., Croft A.M., Black M.M. Dermatological adverse effects with the antimalarial drug mefloquine: a review of 74 published case reports. Clin Exp Dermatol 1999; 24 (4): 249–254PubMedCrossRefGoogle Scholar
  7. 7.
    Bolognia J.L. Cutaneous ulceration: an unusual complication of intravenous pentamidine therapy. Dermatologica 1991; 183 (3): 221–224PubMedCrossRefGoogle Scholar
  8. 8.
    van Puyenbroek E., Stricker B.H. Hypersensitivity reactions to use of mebeverine. Nederlands Tijdschrift voor Geneeskunde 1997; 141 (28): 1392–1395PubMedGoogle Scholar
  9. 9.
    Sancho Calabuig A., Palop Larrea V., Lopez Gonzalez E., et al. Ranitidine and a rare adverse reaction: urticaria. Spanish. Atencion Primaria 1997; 20 (7): 396–397Google Scholar
  10. 10.
    Schneider S., Hebuterne X., Chichmanian R.M., et al. Urticaria caused by omeprazole. Gastroenterologie Clinique et Biologique 1994; 18 (5): 534–535PubMedGoogle Scholar
  11. 11.
    Warner D.M., Ramos-Caro F.A., Flowers F.P. Famotidine (pepcid)-induced symptomatic dermatographism. J Am Acad Dermatol 1994; 31 (4): 677–6778PubMedCrossRefGoogle Scholar
  12. 12.
    Phillips E., Knowles S., Weber E., et al. Skin reactions associated with bisphosphonates: a report of 3 cases and an approach to management. J Allergy Clin Immunol 1998; 102 (4 Pt 1): 697–698PubMedCrossRefGoogle Scholar
  13. 13.
    Mora-Fernandez C., Navarro J.F., Macia M. Urticarial anaphylactoid reaction following metoprolol [letter]. Clin Nephrol 1997; 47 (3): 203PubMedGoogle Scholar
  14. 14.
    Frye C.B., Pettigrew T.J. Angioedema and photosensitive rash induced by valsartan. Pharmacotherapy 1998; 18 (4): 866–868PubMedGoogle Scholar
  15. 15.
    Rivera J.O. Losartan-induced angioedema. Ann Pharmacother 1999; 33 (9): 933–935PubMedCrossRefGoogle Scholar
  16. 16.
    Wutschert R., Piletta P., Bounameaux H. Adverse skin reactions to low molecular weight heparins: frequency, management and prevention. Drug Saf 1999; 20 (6): 515–525PubMedCrossRefGoogle Scholar
  17. 17.
    Weinmann P., Moretti J.L., Leynadier F. Anaphylaxis-like reaction induced by dipyridamole during myocardial scintigraphy. Am J Med 1994; 97 (5): 488PubMedCrossRefGoogle Scholar
  18. 18.
    Rudolf J., Grond M., Prince W.S., et al. Evidence of anaphylaxy after alteplase infusion. Stroke 1999; 30 (5): 1142–1143PubMedCrossRefGoogle Scholar
  19. 19.
    Toubi E., Seligmann H., Golan T.D. Bezalip-induced anaphylaxis. Ann Allergy Asthma Immunol 1995; 75 (4): 370PubMedGoogle Scholar
  20. 20.
    Roger D., Rolle F., Mausset J., et al. Urticarial vasculitis induced by fluoxetine [letter]. Dermatology 1995; 191 (2): 164PubMedCrossRefGoogle Scholar
  21. 21.
    Dachs R., Vitillo J. Angioedema associated with sumatriptan administration. Am J Med 1995; 99 (6): 684–685PubMedCrossRefGoogle Scholar
  22. 22.
    Tripathi A., Greenberger P.A. Bupropion hydrochloride induced serum sicknesslike reaction. Ann Allergy Asthma Immunol 1999; 83 (2): 165–166PubMedCrossRefGoogle Scholar
  23. 23.
    Ciesielski-Carlucci C., Leong P., Jacobs C. Case report of anaphylaxis from cisplatin/paclitaxel and a review of their hypersensitivity reaction profiles. Am J Clin Oncol 1997; 20 (4): 373–375PubMedCrossRefGoogle Scholar
  24. 24.
    Larzilliere I., Brandissou S., Breton P., et al. Anaphylactic reaction to oxaliplatin: a case report. Am J Gastroenterol 1999; 94 (11): 3387–3388PubMedCrossRefGoogle Scholar
  25. 25.
    Rubeiz N.G., Salem Z., Dibbs R., et al. Bleomycin-induced urticarial flagellate drug hypersensitivity reaction. Int J Dermatol 1999; 38 (2): 140–141PubMedCrossRefGoogle Scholar
  26. 26.
    Bourry C., Naveau C., Lazrak K., et al. First case of urticaria due to dacarbazine. Therapie 1995; 50 (6): 588–589PubMedGoogle Scholar
  27. 27.
    al-Lamki Z., Thomas E., el-Banna N., et al. Acute urticaria and hepatitis complicating high-dose methotrexate therapy. Med Pediatr Oncol 1995; 24 (2): 137–140PubMedCrossRefGoogle Scholar
  28. 28.
    Sakaguchi M., Inouye S. Two patterns of systemic immediate-type reactions to Japanese encephalitis vaccines. Vaccine 1998; 16 (1): 68–69PubMedCrossRefGoogle Scholar
  29. 29.
    Sakaguchi M., Nakayama T., Inouye S. Cases of systemic immediate-type urticaria associated with acellular diphtheria-tetanus-pertussis vaccination. Vaccine 1998; 16 (11–12): 1138–1140PubMedCrossRefGoogle Scholar
  30. 30.
    Barbaud A., Trechot P., Reichert-Penetrat S., et al. Allergic mechanisms and urticaria/angioedema after hepatitis B immunization. Br J Dermatol 1998; 139 (5): 925–926PubMedCrossRefGoogle Scholar
  31. 31.
    Valvano M.N., Martin T.P. Periorbital urticaria and topical fluorescein. Am J Emerg Med 1998; 16 (5): 525–526PubMedCrossRefGoogle Scholar
  32. 32.
    Koehler I.K. Acute immediate urticarialike reaction to i.v. injected photofrin. Lasers Surg Med 1997; 20 (1): 97–98PubMedCrossRefGoogle Scholar
  33. 33.
    Bech-Thomsen N., Wulf H.C. 8-Methoxypsoralen urticaria. J Am Acad Dermatol 1994; 31 (6): 1063–1064PubMedCrossRefGoogle Scholar
  34. 34.
    Hunziker T., Kunzi U.P., Braunschweig S., et al. Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20-year survey. Allergy 1997; 52 (4): 388–393PubMedCrossRefGoogle Scholar
  35. 35.
    Bigby M., Jick S., Jick H., et al. Drug-induced cutaneous reactions. A report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975 to 1982. JAMA 1986; 256 (24): 3358–3363PubMedCrossRefGoogle Scholar
  36. 36.
    Stubb S., Heikkila H., Kauppinen K. Cutaneous reactions to drugs: a series of in-patients during a five-year period. Acta Derm Venereol 1994; 74 (4): 289–291PubMedGoogle Scholar
  37. 37.
    Asero R. Aspirin and paracetamol tolerance in patients with nimesulide- induced urticaria. Ann Allergy Asthma Immunol 1998; 81 (3): 237–238PubMedCrossRefGoogle Scholar
  38. 38.
    Anderson M.W., deShazo R.D. Studies of the mechanism of angiotensin-converting enzyme (ACE) inhibitor-associated angioedema: the effect of an ACE inhibitor on cutaneous responses to bradykinin, codeine, and histamine. J Allergy Clin Immunol 1990; 85 (5): 856–858PubMedCrossRefGoogle Scholar
  39. 39.
    Roujeau J.C., Stern R.S. Severe adverse cutaneous reactions to drugs. N Engl J Med 1994; 331 (19): 1272–1285PubMedCrossRefGoogle Scholar
  40. 40.
    Kozel M.M., Mekkes J.R., Bossuyt P.M., et al. The effectiveness of a history-based diagnostic approach in chronic urticaria and angioedema. Arch Dermatol 1998; 134 (12): 1575–1580PubMedCrossRefGoogle Scholar
  41. 41.
    Turner A.N., Whittaker S., Banks S., et al. Plasma exchange in refractory cutaneous vasculitis. Br J Dermatol 1990; 122: 411–415PubMedCrossRefGoogle Scholar
  42. 42.
    Doeglas H.M. Reactions to aspirin and food additives in patients with chronic urticaria, including the physical urticarias. Br J Dermatol 1975; 93 (2): 135–144PubMedCrossRefGoogle Scholar
  43. 43.
    Juhlin L. Recurrent urticaria: clinical investigation of 330 patients. Br J Dermatol 1981; 104 (4): 369–381PubMedCrossRefGoogle Scholar
  44. 44.
    Humphreys F., Hunter J.A. The characteristics of urticaria in 390 patients. Br J Dermatol 1998; 138 (4): 635–638PubMedCrossRefGoogle Scholar
  45. 45.
    Moscicki R.A., Fox R., Kailasam V., et al. Astemizole, steroid sparing effect in urticaria. J Allergy Clin Immunol 1992; 89: 249Google Scholar
  46. 46.
    Breathnach S.M. Mechanisms of drug eruptions: Part I. Austral J Dermatol 1995; 36 (3): 121–127CrossRefGoogle Scholar
  47. 47.
    Wintroub B.U., Stern R. Cutaneous drug reactions: pathogenesis and clinical classification. J Am Acad Dermatol 1985; 13 (2 Pt 1): 167–179PubMedCrossRefGoogle Scholar
  48. 48.
    Gaig P., San Miguel M.M., Enrique E., et al. Selective type-1 hypersensitivity to cefixime. Allergy 1999; 54 (8): 901–902PubMedCrossRefGoogle Scholar
  49. 49.
    Pichichero M.E., Pichichero D.M. Selecting skin testing reagents to predict amoxicillin and cephalosporin allergy. Pediatr Asthma Allergy Immunol 1997; 11 (2): 79–93CrossRefGoogle Scholar
  50. 50.
    Monroe E.W., Cohen S.H., Kalbfleisch J., et al. Combined H1 and H2 antihistamine therapy in chronic urticaria. Arch Dermatol 1981; 117: 404–407PubMedCrossRefGoogle Scholar
  51. 51.
    Garcia J.J., Blanca M., Moreno F., et al. Determination of IgE antibodies to the benzylpenicilloyl determinant: a comparison of the sensitivity and specificity of three radio allergo sorbent test methods. J Clin Lab Anal 1997; 11 (5): 251–257PubMedCrossRefGoogle Scholar
  52. 52.
    Goldfine A.B., Kahn C.R. Insulin allergy and insulin resistance. Curr Ther Endocrinol Metab 1994; 5: 461–464PubMedGoogle Scholar
  53. 53.
    Skov L., Hansen H., Dittmar H.C., et al. Susceptibility to effects of UVB irradiation on induction of contact sensitivity, relevance of number and function of Langerhans cells and epidermal macrophages. Photochem Photobiol 1998; 67 (6): 714–719PubMedCrossRefGoogle Scholar
  54. 54.
    Nolte H., Schiotz O., Skov P.S. A new glass microfibre-based histamine analysis for allergy testing in children. Results compared with conventional leukocyte histamine release assay, skin prick test, bronchial provocation test and RAST. Allergy 1987; 42 (5): 366–373PubMedCrossRefGoogle Scholar
  55. 55.
    Ordoqui E., Zubeldia J.M., Aranzabal A., et al. Serum tryptase levels in adverse drug reactions. Allergy 1997; 52 (11): 1102–1105PubMedCrossRefGoogle Scholar
  56. 56.
    Sullivan T.J., Wedner H.J., Shatz G.S., et al. Skin testing to detect penicillin allergy. J Allergy Clin Immunol 1981; 68 (3): 171–180CrossRefGoogle Scholar
  57. 57.
    Sogn D.D., Evans R., III, et al. Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults. Arch Intern Med 1992; 152 (5): 1025–1032PubMedCrossRefGoogle Scholar
  58. 58.
    Blanca M., Torres M.J., Garcia J.J., et al. Natural evolution of skin test sensitivity in patients allergic to beta- lactam antibiotics. J Allergy Clin Immunol 1999; 103 (5 Pt 1): 918–924PubMedCrossRefGoogle Scholar
  59. 59.
    Barbaud A., Reichert-Penetrat S., Trechot P., et al. The use of skin testing in the investigation of cutaneous adverse drug reactions. Br J Dermatol 1998; 139 (1): 49–58PubMedCrossRefGoogle Scholar
  60. 60.
    Quiralte J., Blanco C., Castillo R., et al. Intolerance to nonsteroidal antiinflammatory drugs: results of controlled drug challenges in 98 patients. J Allergy Clin Immunol 1996; 98 (3): 678–685PubMedCrossRefGoogle Scholar
  61. 61.
    Vieluf D., Przybilla B., Schwerbrock U., et al. Oral provocation test in the diagnosis of anaphylactoid reactions to ‘mild’ analgesic preparations. Int Arch Allergy Immunol 1995; 107 (1-3): 268–271PubMedCrossRefGoogle Scholar
  62. 62.
    Hein U.R., Chantraine-Hess S., Worm M., et al. Evaluation of systemic provocation tests in patients with suspected allergic and pseudoallergic drug reactions, Intolerance to nonsteroidal antiinflammatory drugs: results of controlled drug challenges in 98 patients, Biphasic systemic anaphylaxis: an inpatient and outpatient study. Acta Derm Venereol 1999; 79 (2): 139–142PubMedCrossRefGoogle Scholar
  63. 63.
    Martin-Munoz F., Moreno-Ancillo A., Dominguez-Noche C., et al. Evaluation of drug-related hypersensitivity reactions in children. J Invest Allergol Clin Immunol 1999; 9 (3): 172–177Google Scholar
  64. 64.
    Ballmer-Weber B.K., Gex-Collet C., Wuthrich B. Inhibition of histamine or allergeninduced wheals by a single dose of acrivastine, fexofenadine or cetirizine. J Investig Allergol Clin Immunol 1999 Nov–Dec; 9 (6): 351–355PubMedGoogle Scholar
  65. 65.
    Zuberbier T., Ifflander J., Semmler C., et al. Acute urticaria: clinical aspects and therapeutic responsiveness. Acta Derm Venerol 1996 Jul; 76 (4): 295–297PubMedGoogle Scholar
  66. 66.
    Runge J.W., Martinez J.C., Caravati E.M., et al. Histamine antagonists in the treatment of acute allergic reactions. Ann Emerg Med 1992 Mar; 21 (3): 237–242PubMedCrossRefGoogle Scholar
  67. 67.
    Douglas D.M., Sukenick E., Andrade W.P., et al. Biphasic systemic anaphylaxis: an inpatient and outpatient study. J Allergy Clin Immunol 1994; 93 (6): 977–985PubMedCrossRefGoogle Scholar
  68. 68.
    Project team of the resuscitation council Emergency treatment of anaphylaxis. J Accident Emerg Med 2000; 16: 243–247Google Scholar
  69. 69.
    Grzelewska-Rzymowska I., Roznlecki J., Szmidt M. Aspirin ‘desensitization’ in patients with aspirin-induced urticaria and angioedema. Allergologia Immunopathol 1988; 16 (5): 305–308Google Scholar
  70. 70.
    Stark B.J., Earl H.S., Gross G.N., et al. Acute and chronic desensitization of penicillinallergic patients using oral penicillin. J Allergy Clin Immunol 1987; 79 (3): 523–532PubMedCrossRefGoogle Scholar
  71. 71.
    Borish L., Tamir R., Rosenwasser L.J. Intravenous desensitization to beta-lactam antibiotics. J Allergy Clin Immunol 1987; 80 (3 Pt 1): 314–319PubMedCrossRefGoogle Scholar
  72. 72.
    Rowinsky E.K., Donehower R.C. Paclitaxel (taxol). N Engl J Med 1995; 332 (15): 1004–1014PubMedCrossRefGoogle Scholar
  73. 73.
    Pumphrey R.S. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000; 30 (8): 1144–1150PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Department of DermatologyGrampian University Hospitals NHS Trust, Aberdeen Royal Infirmary, ForesterhillAberdeenScotland

Personalised recommendations