Asia Pac Allergy.  2015 Jul;5(3):177-180. 10.5415/apallergy.2015.5.3.177.

Chlorpheniramine-induced anaphylaxis diagnosed by basophil activation test

• Lee HS
• Song WJ
• Lee JW
• Cho YY
• Park HK
• Kang MG
• Cho SH
• Sohn SW

• KMID: 2397048
• DOI: http://doi.org/10.5415/apallergy.2015.5.3.177

Abstract

Chlorpheniramine is a widely prescribed H1-antihistamine for relieving urticaria or histamine-mediated allergic reactions. However, although rare, it may cause immediate hypersensitivity reactions. The diagnosis is usually made by provocation test, but its application is often limited due to comorbidities or potential risk of severe reactions. In those cases, skin tests and basophil activation tests can be considered as additional diagnostic tests for the drug allergy. Here, we report a 33-year-old female with underlying chronic urticaria, who recurrently developed anaphylaxis after chlorpheniramine administration. Intradermal test showed positive responses in the patient at 0.02 mg/mL of chlorpheniramine, but not in healthy controls. Basophil activation test showed significant up-regulation of CD63 and CD203c by chlorpheniramine. The present case reminds the rare but potential allergic risk of chlorpheniramine, and also suggests the potential utility of basophil activation test in making the diagnosis.

Keyword

Drug Hypersensitivity; Anaphylaxis; Basophils

MeSH Terms

Adult
Anaphylaxis*
Basophils*
Chlorpheniramine
Comorbidity
Diagnosis
Diagnostic Tests, Routine
Drug Hypersensitivity
Female
Humans
Hypersensitivity
Hypersensitivity, Immediate
Intradermal Tests
Skin Tests
Up-Regulation
Urticaria
Chlorpheniramine

Figure

• 

  Fig. 1 Basophil activation tests with chlorpheniramine. The bar results indicate the percentage of basophil activation markers CD63/CD203c after stimulation with positive control (anti-FcεRI monoclonal antibody), negative control (buffer), chlorpheniramine, carrier protein, or chlorpheniramine conjugated with carrier protein.

Reference

1. Kim MH, Lee SM, Lee SH, Kwon HS, Kim SH, Cho SH, Min KU, Kim YY, Chang YS. A case of chlorpheniramine maleate-induced hypersensitivity with aspirin intolerance. Allergy Asthma Immunol Res. 2011; 3:62–64.

2. Lee SH, Jung HS, Yoon TY, Chang EJ, Kim MK, Kim KS. Allergic reaction to chlorpheniramine in a patient with aspirin-intolerant asthma. Korean J Asthma Allergy Clin Immunol. 2010; 30:55–58.

3. Kim YJ, Choi JH, Bang JS, Suh MK, Lee JW, Kim TH. A case of pheniramine maleate - aggravated chronic urticaria. Korean J Dermatol. 2000; 38:1414–1415.

4. Caceres Calle O, Fernandez-Benitez M. Allergy to dexchlorpheniramine: study of a case. Allergol Immunopathol (Madr). 2004; 32:306–309.

5. Rodríguez del Río P, Gonzalez-Gutierrez ML, Sanchez-Lopez J, Nunez-Acevedo B, Bartolome Alvarez JM, Martinez-Cocera C. Urticaria caused by antihistamines: report of 5 cases. J Investig Allergol Clin Immunol. 2009; 19:317–320.

6. Thurot-Guillou C, Bourrain JL, Jacquier JP, Beani JC. Anaphylactic reaction to ranitidine and dexchlorpheniramine. Eur J Dermatol. 2007; 17:170–171.

7. Romano A, Torres MJ, Castells M, Sanz ML, Blanca M. Diagnosis and management of drug hypersensitivity reactions. J Allergy Clin Immunol. 2011; 127:3 Suppl. S67–S73.

8. Song WJ, Chang YS. Recent applications of basophil activation tests in the diagnosis of drug hypersensitivity. Asia Pac Allergy. 2013; 3:266–280.

9. McGowan EC, Saini S. Update on the performance and application of basophil activation tests. Curr Allergy Asthma Rep. 2013; 13:101–109.

10. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, Brockow K, Pichler WJ, Demoly P. European Network for Drug Allergy (ENDA). EAACI interest group on drug hypersensitivity. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy. 2003; 58:854–863.

11. Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo C, Mertes PM, Mosbech H, Nasser S, Pagani M, Ring J, Romano A, Scherer K, Schnyder B, Testi S, Torres M, Trautmann A, Terreehorst I. ENDA/EAACI Drug Allergy Interest Group. Skin test concentrations for systemically administered drugs: an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013; 68:702–712.

12. Empedrad R, Darter AL, Earl HS, Gruchalla RS. Nonirritating intradermal skin test concentrations for commonly prescribed antibiotics. J Allergy Clin Immunol. 2003; 112:629–630.

13. Steiner M, Harrer A, Lang R, Schneider M, Ferreira T, Hawranek T, Himly M. Basophil activation test for investigation of IgE-mediated mechanisms in drug hypersensitivity. J Vis Exp. 2011; (55):pii: 3263.

14. Mayorga C, Andreu I, Aranda A, Dona I, Montanez MI, Blanca-Lopez N, Ariza A, Nuin E, Blanca M, Miranda MA, Torres MJ. Fluoroquinolone photodegradation influences specific basophil activation. Int Arch Allergy Immunol. 2013; 160:377–382.

15. De Week AL, Sanz ML, Gamboa PM, Aberer W, Bienvenu J, Blanca M, Demoly P, Ebo DG, Mayorga L, Monneret G, Sainte Laudy J. Diagnostic tests based on human basophils: more potentials and perspectives than pitfalls II Technical issues. J Investig Allergol Clin Immunol. 2008; 18:143–155.

16. Vasagar K, Vonakis BM, Gober LM, Viksman A, Gibbons SP Jr, Saini SS. Evidence of in vivo basophil activation in chronic idiopathic urticaria. Clin Exp Allergy. 2006; 36:770–776.