ABSTRACT
A 26-year-old male suffering from acute rhinitis took the first dose of Zolistan (mizolastine, 10 mg), orally, and 15 minutes later he developed intense generalized pruritus, cutaneous rash, oropharyngeal pruritus, edema on his face, difficulty in swallowing, and mild dyspnea. He was treated with methylprednisolone and epinephrine and improved within 30 minutes. The patient had not taken mizolastine before and he has avoided it since the reaction. Cutaneous tests with Zolistan and its excipients proved negative. Simple-blind oral challenge tests with the excipients and then with Zolistan were positive only with Zolistan. In order to confirm the absence of cross-reactivity between mizolastine and other benzimidazoles, we tested omeprazole, domperidone and mebendazole, all of which yielded negative results. To our knowledge, this is the second case of immediate hypersensitivity to mizolastine documented to date. In our case, the clinical history, physical examination and provocation tests allow us to establish the diagnosis of hypersensitivity to mizolastine and exclude the cross reactivity with other benzimidazole derivatives.
Subject(s)
Benzimidazoles/adverse effects , Drug Hypersensitivity/immunology , Histamine H1 Antagonists, Non-Sedating/adverse effects , Acute Disease , Adult , Benzimidazoles/immunology , Cross Reactions , Histamine H1 Antagonists, Non-Sedating/immunology , Humans , Male , Rhinitis/drug therapyABSTRACT
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Subject(s)
Male , Middle Aged , Humans , Drug Hypersensitivity/complications , Heparin Antagonists/adverse effects , Hypertension, Pulmonary/chemically induced , Hypertension, Pulmonary/diagnosis , Protamines/adverse effects , Skin TestsABSTRACT
Because seafood consumption is moderate-to-high in Spain, allergic reactions to seafood such as fish, crustacea and mollusc are fairly frequent. The clinical features of these reactions depend on the implicated species and whether the reaction is provoked by ingestion, handling or vapor inhalation. Because different species have common antigenic structures, cross-sensitization is frequent, especially between crustaceans and molluscs. Contamination of fish by nematodes (Anisakis) may produce severe reactions. We report the case of a female patient with no personal or family history of allergy who experienced two episodes of anaphylactic shock: the first occurred immediately after eating oysters and the second after ingestion of white fish. The patient also developed generalized urticaria provoked by crustacean (prawns) and white fish. The results of skin prick tests were negative for fish, shellfish, crustacean and oysters while in vitro tests were positive for oyster, prawns, Anisakis, Ascaris and Echinococcus, although stool samples and gastric endoscopy were negative.
Subject(s)
Anaphylaxis/etiology , Anisakis , Decapoda , Fishes/parasitology , Food Hypersensitivity/etiology , Ostreidae , Seafood/adverse effects , Urticaria/etiology , Allergens , Animals , Anisakis/immunology , Ascaris/immunology , Child , Cross Reactions , Decapoda/immunology , Echinococcus/immunology , Endoscopy, Digestive System , Female , Humans , Middle Aged , Ostreidae/immunology , Skin TestsABSTRACT
Because seafood consumption is moderate-to-high in Spain, allergic reactions to seafood such as fish, crustacea and mollusc are fairly frequent. The clinical features of these reactions depend on the implicated species and whether the reaction is provoked by ingestion, handling or vapor inhalation. Because different species have common antigenic structures, cross-sensitization is frequent, especially between crustaceans and molluscs. Contamination of fish by nematodes (Anisakis) may produce severe reactions. We report the case of a female patient with no personal or family history of allergy who experienced two episodes of anaphylactic shock: the first occurred immediately after eating oysters and the second after ingestion of white fish. The patient also developed generalized urticaria provoked by crustacean (prawns) and white fish. The results of skin prick tests were negative for fish, shellfish, crustacean and oysters while in vitro tests were positive for oyster, prawns, Anisakis, Ascaris and Echinococcus, although stool samples and gastric endoscopy were negative (AU)
Como el consumo de alimentos procedentes del mar en España es de moderado a elevado, las reacciones alérgicas a pescados, crustáceos y moluscos son bastante frecuentes. Las características clínicas de dichas reacciones dependen de las especies implicadas y de si la reacción está provocada por ingestión, manipulación o inhalación de vapores. Como distintas especies tienen estructuras antigénicas comunes, la sensibilización cruzada es frecuente, especialmente entre los crustáceos y los moluscos. La contaminación del pescado por nematodos (Anisakis) puede producir reacciones graves. Describimos el caso de una mujer sin antecedentes personales ni familiares de alergia que experimentó dos episodios de shock anafilático: el primero se produjo inmediatamente después de tomar ostras y el segundo, después de comer pescado blanco. La paciente también sufrió una urticaria generalizada provocada por crustáceos (gambas) y pescado blanco. Los resultados de las pruebas de punción cutánea fueron negativas para pescado, mariscos, crustáceos y ostras, mientras que las pruebas in vitro fueron positivas para ostras, gambas, Anisakis, Ascaris y Echinococcus, si bien las muestras de heces y la endoscopia gástrica resultaron negativas (AU)