Cansino-Torres Mariana Aurora, Sandoval-Rodríguez Valeria, Sáenz-Farret Michel, Zúñiga-Ramírez Carlos
Movement Disorders and Neurodegenerative Diseases Unit, Hospital Civil de Guadalajara, "Fray Antonio Alcalde," Guadalajara, Mexico.
Clin Neuropharmacol. 2018 Mar/Apr;41(2):75-79. doi: 10.1097/WNF.0000000000000270.
D-Decarboxylase inhibitors, such as carbidopa or benserazide, have been used as adjunct therapy in Parkinson disease shortly after levodopa synthesis in the 1960s. These compounds increase intracerebral drug concentration and decrease adverse effects by blocking peripheral conversion to dopamine. Skin rash as part of an allergic reaction was previously described in subjects who were using levodopa in combination with carbidopa or benserazide; however, etiology was never clear. Allergic reactions to carbidopa have not previously been reported.
We report a case of a 77-year-old woman with a diagnosis of idiopathic Parkinson disease, who developed autonomic and dermatological signs: conjunctival injection, rhinorrhea, excessive sweating, hypertension, and pruritic generalized rash, among others, immediately after carbidopa/levodopa administration regardless of the manufacturer. Treatment with dexamethasone combined with chloropyramine hydrochloride resulted in complete resolution of the hypersensitivity reaction each time it presented. The autonomic and dermatological manifestations did not reappear after treatment was replaced with benserazide/levodopa.
To the best of our knowledge, this is the first case report of an allergic reaction specific to carbidopa. Our case highlights the importance of identifying the source of a hypersensitivity drug response, whether it is caused by the active component or by the excipients.
20世纪60年代左旋多巴合成后不久，脱羧酶抑制剂，如卡比多巴或苄丝肼，就已被用作帕金森病的辅助治疗药物。这些化合物可提高脑内药物浓度，并通过阻断外周向多巴胺的转化来减少不良反应。先前有使用左旋多巴联合卡比多巴或苄丝肼的患者出现皮疹，作为过敏反应的一部分；然而，病因一直不明。此前尚未有关于卡比多巴过敏反应的报道。
我们报告了一例77岁诊断为特发性帕金森病的女性病例，她在服用卡比多巴/左旋多巴后立即出现自主神经和皮肤症状：结膜充血、流涕、多汗、高血压和全身性瘙痒皮疹等，无论药物生产商如何。每次出现过敏反应时，用地塞米松联合盐酸氯苯那敏治疗可使过敏反应完全消退。改用苄丝肼/左旋多巴治疗后，自主神经和皮肤表现未再出现。
据我们所知，这是首例关于卡比多巴特异性过敏反应的病例报告。我们的病例强调了确定过敏药物反应来源的重要性，无论其是由活性成分还是辅料引起的。
