Hydrochlorothiazide-induced acute pulmonary edema.

OBJECTIVE: To describe a patient with noncardiogenic acute pulmonary edema induced by hydrochlorothiazide. CASE SUMMARY: A 70-year-old woman in generally good health, except for mild pedal edema, developed acute pulmonary edema after ingesting hydrochlorothiazide 12.5 mg for the first time. DISCUSSION: This is the fifteenth reported case of noncardiogenic pulmonary edema induced by hydrochlorothiazide. The investigations by previous authors seemed to rule out an immunologic mechanism; thus, the pathogenesis of the reaction is unknown. Most of the reactions have occurred in women. CONCLUSIONS: Noncardiogenic pulmonary edema appears to be an idiosyncratic reaction that occurs with some specificity with the thiazide diuretics. Clinicians should be aware of this potential, serious adverse reaction that occurs without warning.

Correlation of serum theophylline levels with inhibition of allergen and histamine-induced skin tests.

The purpose of this study was to determine if clinically effective serum levels of theophylline have an inhibitory effect on intradermal tests for allergic hypersensitivity. Intradermal testing using the threshold-dilution technique was performed in 9 patients, 7 of whom were sensitive to 2 antigens. Testing was performed over a 6-hour period after theophylline administration and compared with the control results. Inhibition of the end-point was demonstrated with 12 of 16 antigens tested associated with serum theophylline levels ranging from 7 to 20 microgram/ml. Marked inhibition of the intradermal tests, that might have clinical significance, only occurred with 4 antigens.