Allergy Asthma Immunol Res.  2011 Jan;3(1):62-64. 10.4168/aair.2011.3.1.62.

A Case of Chlorpheniramine Maleate-Induced Hypersensitivity With Aspirin Intolerance

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. addchang@sun.ac.kr
  • 2Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.
  • 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 4Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea.

Abstract

Antihistamines are commonly used to treat allergic disease, such as allergic rhinitis, urticaria, and angioedema. Although several previous reports describe hypersensitivity to antihistamines such as cetirizine and hydroxyzine, documented cases of chlorpheniramine hypersensitivity are extremely rare. Here, we report the case of a 45-year-old Korean woman who presented with urticaria after ingesting a cold medication. Over the previous 5 years, she had also experienced a food allergy to crab and shrimp, allergic rhinitis, and repeated urticaria after ingesting cold medication. Provocation with aspirin elicited generalized urticaria. Intravenous chlorpheniramine and methylprednisolone was injected for symptom control, but in fact appeared to aggravate urticaria. A second round of skin and provocation tests for chlorpheniramine and methylprednisolone showed positive results only for chlorpheniramine. She was diagnosed with aspirin intolerance and chlorpheniramine hypersensitivity, and was instructed to avoid these drugs. To date, this is the second of only two cases of chlorpheniramine-induced type I hypersensitivity with aspirin intolerance. Although the relationship between aspirin intolerance and chlorpheniramine-induced type I hypersensitivity is unclear, physicians should be aware of the possibility of urticaria or other allergic reactions in response to antihistamines.

Keyword

Aspirin; chlorpheniramine; drug hypersensitivity; hypersensitivity; urticaria

MeSH Terms

Angioedema
Aspirin
Cetirizine
Chlorpheniramine
Cold Temperature
Drug Hypersensitivity
Female
Food Hypersensitivity
Histamine Antagonists
Humans
Hydroxyzine
Hypersensitivity
Hypersensitivity, Immediate
Methylprednisolone
Middle Aged
Rhinitis
Rhinitis, Allergic, Perennial
Skin
Urticaria
Aspirin
Cetirizine
Chlorpheniramine
Histamine Antagonists
Hydroxyzine
Methylprednisolone

Figure

  • Figure Intradermal test showed positive response only to chlorpheniramine (M, methylprednisolone; C, hydrocortisone; D, dexamethasone; T, triamcinolone; N, normal saline; Ph, chlorpheniramime; H, histamine; ×1/10, 1:10 dilution; ×1/100, 1:100 dilution).


Cited by  3 articles

Anaphylaxis to Chlorpheniramine Maleate and Literature Review
Yong Won Choi, Min Je Jung, Hye One Kim, Bo Young Chung, Chun Wook Park
Ann Dermatol. 2019;31(4):438-441.    doi: 10.5021/ad.2019.31.4.438.

Drug hypersensitivity to various antihistamines with cross-reactions
Young Uck Kim, Jaechun Lee
Allergy Asthma Respir Dis. 2014;2(2):134-137.    doi: 10.4168/aard.2014.2.2.134.

Chlorpheniramine-induced anaphylaxis diagnosed by basophil activation test
Hyun-Seung Lee, Woo-Jung Song, Ji-Won Lee, Young-Yoon Cho, Han-Ki Park, Min-Gyu Kang, Sang-Heon Cho, Seong-Wook Sohn
Asia Pac Allergy. 2015;5(3):177-180.    doi: 10.5415/apallergy.2015.5.3.177.


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