Simultaneous hypersensitivity tometronidazole and spiramycin

  1. E Moreno 1
  2. E Macias 1
  3. A Ruiz 1
  4. I Dávila 1
  5. E Laffond 1
  6. M Isidoro-García 1
  7. C Sanz 1
  8. M Pascual 1
  9. F Lorente 1
  1. 1 Hospital Universitario de Salamanca
    info

    Hospital Universitario de Salamanca

    Salamanca, España

    ROR https://ror.org/0131vfw26

Actas:
Allergy

ISSN: 0105-4538,  1398-9995

Año de publicación: 2007

Volumen: 62

Número: s83

Páginas: 548-548

Congreso: Congress of the European Academy of Allergology and Clinical Immunology

Tipo: Aportación congreso

GOOGLE SCHOLAR

Resumen

Rhodogils(125 mg metronidazole and750.000 IU spiramycin) is a combinationwidely used in Spain for dental infections.It is well tolerated and hypersensitivityreactions have been exceptionally described.Of the two drugs, metronidazole is the mostfrequent involved. We present a 45-year-oldman who developed an immediate urticarialreaction after receiving a single dose ofRhodogilsand 600 mg of ibuprofen due toa dental abscess. Skin prick e intradermaltests with metronidazole were negative.Single blind placebo controlled oral provo-cation (SBPCOP) with increasing doses ofibuprofen up to 600 mg was negative.SBPCOP with metronidazole was positive.After the dose 125 mg the patient experi-enced generalized pruritus, urticaria anddysphonia. He rapidly recovered with IMepinephrine, methylprednisolone and dexchlorphenamine, but after 1 h he startedagain with pruritus and generalized erithe-ma. Epinephrine and metilprednisolonewere administrated and he recovered in 6 h.After 4 weeks a SBPCOP with spiramycinwas performed. Two hours after a fulltherapeutic dose of 75.000 IU the patientdeveloped a generalized exanthema withfacial erithema that resolved with corticos-teroids and antihistamines. Hypersensitivityreactions to metronidazole are rare as wellas are allergic reactions to macrolidesincluding spiramycin. Skin tests are usuallynegatives and most reactions have beendiagnosed by provocation tests. Simulta-neous allergic reactions to both drugs havenot been reported. Hypersensitivity to twoor more chemically different drugs or multi-ple drug hypersensitivity is also a raredisorder. Two subtypes have been sug-gested, one in which multiple hypersensitiv-ity develops against different drugs givensimultaneously, and another in which sensi-tisations develop sequentially. Our caseseems to belong to the first type. Insummary we present a case report ofsimultaneous sensitisation to both metroni-dazole and spiramycin demonstrated by oralchallenge.