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Cutaneous adverse drug reaction type erythema multiforme major induced by eslicarbazepine.

Massot A, Gimenez-Arnau A - J Pharmacol Pharmacother (2014)

Bottom Line: The patient was not carrier of the HLA alleles A3101 and B1502 associated with CBZ induced EMM.However, the patch and intradermal tests in our patient did not show a delayed reaction but an immediate cutaneous one.A first allergic episode may elicit a massive nonspecific activation of the immune system, providing an enhanced expression of co-stimulatory molecules that decreases the level of tolerance to other drugs.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Hospital del Mar. Barcelona, Spain.

ABSTRACT
Severe skin reactions occur less frequently with eslicarbazepine (ESL) than with the other aromatic anticonvulsants. We report the first case of cutaneous adverse drug reaction (CADR) to ESL and co-sensitization between ESL and betalactams. A 41-year-old white woman developed focal epilepsy due to a meningioma that was removed. As post-operatory complication, she suffered meningitis as well as a maculo-papular erythema caused by the treatment with meropenem. Subsequently, ESL was started and gradually increased until 800 mg/day. Twenty-five days later, the patient developed an Erythema Multiforme Major (EMM). Strong positive immediate reaction was induced by prick test with carbamazepine (CBZ) and ESL at 0.01 and 0.1% within 15 and 30 minutes; however the delayed reading at 48 hours was negative. The patient was not carrier of the HLA alleles A3101 and B1502 associated with CBZ induced EMM. The hypersensitivity pathogenic mechanism of EMM is unclear and a delayed hypersensitivity process is speculated. However, the patch and intradermal tests in our patient did not show a delayed reaction but an immediate cutaneous one. A first allergic episode may elicit a massive nonspecific activation of the immune system, providing an enhanced expression of co-stimulatory molecules that decreases the level of tolerance to other drugs. When prescribing ESL, we suggest ruling out previous CADR, especially to CBZ and oxcarbazepine but also other chemically unrelated drugs such as beta-lactams.

No MeSH data available.


Related in: MedlinePlus

Prick test showing a strong positive immediate reaction with carbamazepine and eslicarbazepine at 0.1 and 0.01% concentrations
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Figure 2: Prick test showing a strong positive immediate reaction with carbamazepine and eslicarbazepine at 0.1 and 0.01% concentrations

Mentions: A strong positive immediate reaction could be induced by prick test and intradermic test with ESL and CBZ at 0.01 and 0.1% concentrations in aqua. The reaction was observed at 15 and 30 mins. but, paradoxically, not in the delayed reading at 48 hrs [Figure 2]. Epicutaneous pharmacological testing with ESL and CBZ was negative. Patch testing with the European series just showed delayed hypersensitivity to nickel sulfate.


Cutaneous adverse drug reaction type erythema multiforme major induced by eslicarbazepine.

Massot A, Gimenez-Arnau A - J Pharmacol Pharmacother (2014)

Prick test showing a strong positive immediate reaction with carbamazepine and eslicarbazepine at 0.1 and 0.01% concentrations
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231563&req=5

Figure 2: Prick test showing a strong positive immediate reaction with carbamazepine and eslicarbazepine at 0.1 and 0.01% concentrations
Mentions: A strong positive immediate reaction could be induced by prick test and intradermic test with ESL and CBZ at 0.01 and 0.1% concentrations in aqua. The reaction was observed at 15 and 30 mins. but, paradoxically, not in the delayed reading at 48 hrs [Figure 2]. Epicutaneous pharmacological testing with ESL and CBZ was negative. Patch testing with the European series just showed delayed hypersensitivity to nickel sulfate.

Bottom Line: The patient was not carrier of the HLA alleles A3101 and B1502 associated with CBZ induced EMM.However, the patch and intradermal tests in our patient did not show a delayed reaction but an immediate cutaneous one.A first allergic episode may elicit a massive nonspecific activation of the immune system, providing an enhanced expression of co-stimulatory molecules that decreases the level of tolerance to other drugs.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Hospital del Mar. Barcelona, Spain.

ABSTRACT
Severe skin reactions occur less frequently with eslicarbazepine (ESL) than with the other aromatic anticonvulsants. We report the first case of cutaneous adverse drug reaction (CADR) to ESL and co-sensitization between ESL and betalactams. A 41-year-old white woman developed focal epilepsy due to a meningioma that was removed. As post-operatory complication, she suffered meningitis as well as a maculo-papular erythema caused by the treatment with meropenem. Subsequently, ESL was started and gradually increased until 800 mg/day. Twenty-five days later, the patient developed an Erythema Multiforme Major (EMM). Strong positive immediate reaction was induced by prick test with carbamazepine (CBZ) and ESL at 0.01 and 0.1% within 15 and 30 minutes; however the delayed reading at 48 hours was negative. The patient was not carrier of the HLA alleles A3101 and B1502 associated with CBZ induced EMM. The hypersensitivity pathogenic mechanism of EMM is unclear and a delayed hypersensitivity process is speculated. However, the patch and intradermal tests in our patient did not show a delayed reaction but an immediate cutaneous one. A first allergic episode may elicit a massive nonspecific activation of the immune system, providing an enhanced expression of co-stimulatory molecules that decreases the level of tolerance to other drugs. When prescribing ESL, we suggest ruling out previous CADR, especially to CBZ and oxcarbazepine but also other chemically unrelated drugs such as beta-lactams.

No MeSH data available.


Related in: MedlinePlus