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A case of anaphylaxis to oral minocycline.

Jang JW, Bae YJ, Kim YG, Jin YJ, Park KS, Cho YS, Moon HB, Kim TB - J. Korean Med. Sci. (2010)

Bottom Line: Minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris.She developed urticaria, angioedema, nausea, vomiting, hypotension, and dyspnea within 4 min and was treated with intramuscular epinephrine, intravenous antihistamine and systemic corticosteroid.However, she presented similar symptoms at 50 min and at 110 min.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

ABSTRACT
Minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris. To date, there has been only one case report of anaphylaxis to minocycline. We report here a case of anaphylaxis to oral minocycline. A 56-yr-old woman visited our hospital after three episodes of recurrent anaphylaxis. We performed an oral challenge test, the standard method for diagnosing drug allergies, with minocycline, one of the drugs she had taken previously. She developed urticaria, angioedema, nausea, vomiting, hypotension, and dyspnea within 4 min and was treated with intramuscular epinephrine, intravenous antihistamine and systemic corticosteroid. However, she presented similar symptoms at 50 min and at 110 min. In prescribing oral minocycline, physicians should consider the possibility of serious adverse reactions, such as anaphylaxis.

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Related in: MedlinePlus

Changes in blood pressure following an oral minocycline challenge test. Arrows indicate times at which drugs were administered, including epinephrine, antihistamine, and systemic corticosteroids.
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Figure 2: Changes in blood pressure following an oral minocycline challenge test. Arrows indicate times at which drugs were administered, including epinephrine, antihistamine, and systemic corticosteroids.

Mentions: We performed an oral minocycline challenge test to confirm the causative drug of her recurrent anaphylaxis. The patient took a half capsule of Minocin [50 mg]® (SK Chemical Life Science, Seoul, Korea). Within 4 min, she began to feel an itching and burning sensation in her face and forearms, followed by the development of generalized wheal. She also presented with periorbital and lip swelling (Fig. 1). In 10 min she developed throat discomfort, dyspnea and wheezing. She was distressed because of nausea, vomiting and dizziness. On physical examination, we heard a wheezing sound in her whole lung field and an abrupt fall in blood pressure, to 70/50 mmHg. At that time, her pulse rate was 55 beats/min, her respiratory rate was 24/min, and her SpO2 was 93%. She was administered two 0.3 cc doses of epinephrine intramuscularly 5-min apart, along with intravenous chlorpheniramine (H1-antagonist) 4 mg, famotidine (H2-antagonist) 20 mg and hydrocortisone 250 mg. The patient also inhaled an albuterol nebulizer (short-acting B2-agonist). Ten minutes later, her blood pressure had increased to 105/70 mmHg. Thirty minutes later, however, she again developed hypotension (80/40 mmHg), for which she was treated with additional intramuscular epinephrine. After 1 hr, she again developed hypotension (80/40 mmHg) (Fig. 2), for which she was managed with the same regimen. On the following day, the patient had fully recovered without apparent complications and discharged. She was educated about avoidance of tetracycline and given a 'drug-alert card'. Since stopping minocycline, she has experienced no additional episodes of anaphylaxis.


A case of anaphylaxis to oral minocycline.

Jang JW, Bae YJ, Kim YG, Jin YJ, Park KS, Cho YS, Moon HB, Kim TB - J. Korean Med. Sci. (2010)

Changes in blood pressure following an oral minocycline challenge test. Arrows indicate times at which drugs were administered, including epinephrine, antihistamine, and systemic corticosteroids.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908797&req=5

Figure 2: Changes in blood pressure following an oral minocycline challenge test. Arrows indicate times at which drugs were administered, including epinephrine, antihistamine, and systemic corticosteroids.
Mentions: We performed an oral minocycline challenge test to confirm the causative drug of her recurrent anaphylaxis. The patient took a half capsule of Minocin [50 mg]® (SK Chemical Life Science, Seoul, Korea). Within 4 min, she began to feel an itching and burning sensation in her face and forearms, followed by the development of generalized wheal. She also presented with periorbital and lip swelling (Fig. 1). In 10 min she developed throat discomfort, dyspnea and wheezing. She was distressed because of nausea, vomiting and dizziness. On physical examination, we heard a wheezing sound in her whole lung field and an abrupt fall in blood pressure, to 70/50 mmHg. At that time, her pulse rate was 55 beats/min, her respiratory rate was 24/min, and her SpO2 was 93%. She was administered two 0.3 cc doses of epinephrine intramuscularly 5-min apart, along with intravenous chlorpheniramine (H1-antagonist) 4 mg, famotidine (H2-antagonist) 20 mg and hydrocortisone 250 mg. The patient also inhaled an albuterol nebulizer (short-acting B2-agonist). Ten minutes later, her blood pressure had increased to 105/70 mmHg. Thirty minutes later, however, she again developed hypotension (80/40 mmHg), for which she was treated with additional intramuscular epinephrine. After 1 hr, she again developed hypotension (80/40 mmHg) (Fig. 2), for which she was managed with the same regimen. On the following day, the patient had fully recovered without apparent complications and discharged. She was educated about avoidance of tetracycline and given a 'drug-alert card'. Since stopping minocycline, she has experienced no additional episodes of anaphylaxis.

Bottom Line: Minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris.She developed urticaria, angioedema, nausea, vomiting, hypotension, and dyspnea within 4 min and was treated with intramuscular epinephrine, intravenous antihistamine and systemic corticosteroid.However, she presented similar symptoms at 50 min and at 110 min.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

ABSTRACT
Minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris. To date, there has been only one case report of anaphylaxis to minocycline. We report here a case of anaphylaxis to oral minocycline. A 56-yr-old woman visited our hospital after three episodes of recurrent anaphylaxis. We performed an oral challenge test, the standard method for diagnosing drug allergies, with minocycline, one of the drugs she had taken previously. She developed urticaria, angioedema, nausea, vomiting, hypotension, and dyspnea within 4 min and was treated with intramuscular epinephrine, intravenous antihistamine and systemic corticosteroid. However, she presented similar symptoms at 50 min and at 110 min. In prescribing oral minocycline, physicians should consider the possibility of serious adverse reactions, such as anaphylaxis.

Show MeSH
Related in: MedlinePlus