Sim Da Woon, Yu Ji Eun, Koh Young-Il
Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
Allergy Asthma Clin Immunol. 2021 Feb 5;17(1):15. doi: 10.1186/s13223-021-00517-6.
Erdosteine is used as a mucolytic agent and has a low incidence of adverse drug reactions, most of which are gastrointestinal and mild. Moreover, drug antigens rarely induce multiple simultaneous immunologic reactions. Only one previous case report has demonstrated hypersensitivity reaction induced by erdosteine. Here, we report a case of fixed drug eruption and anaphylaxis, which were concurrently induced by erdosteine. The association between the symptoms and erdosteine was proven by a drug provocation test.
A 35-year-old woman presented with recurrent angioedema and pruritic rash on the hands, which developed within 2 h following the administration of drugs, including erdosteine, for acute upper respiratory infection. Her rash was characterized by well-defined erythematous plaques, which recurred at the same site following the administration of the medications. She also experienced angioedema of the lips. Fixed drug eruption was considered after excluding other possible causes for the presented skin lesions. A drug provocation test confirmed that fixed drug eruption on both hands had occurred after administration of erdosteine, suggesting that erdosteine was the cause of the allergic reaction. However, she also experienced angioedema, isolated wheal, and laryngeal edema; thus, IgE-mediated type I hypersensitivity could also be concurrently occurring with the fixed drug eruption.
We report about a patient who was diagnosed with two different hypersensitivity reactions concurrently induced by erdosteine. We also demonstrate that patients may exhibit multiple simultaneous symptoms that usually arise from overlapping of different hypersensitivity mechanisms. Physicians should be aware of the possibility that some patients who are allergic to certain drugs could exhibit several symptoms caused by different mechanisms of hypersensitivity reactions simultaneously.
厄多司坦用作黏液溶解剂，药物不良反应发生率低，多数为胃肠道反应且症状较轻。此外，药物抗原很少引发多种同时发生的免疫反应。此前仅有一例病例报告显示厄多司坦可诱发过敏反应。在此，我们报告一例由厄多司坦同时诱发的固定性药疹和过敏反应。通过药物激发试验证实了症状与厄多司坦之间的关联。
一名35岁女性因急性上呼吸道感染服用包括厄多司坦在内的药物后2小时内，双手反复出现血管性水肿和瘙痒性皮疹。她的皮疹表现为边界清晰的红斑，用药后在同一部位复发。她还出现了唇部血管性水肿。排除其他可能导致所呈现皮肤病变的原因后，考虑为固定性药疹。药物激发试验证实服用厄多司坦后双手出现固定性药疹，提示厄多司坦是过敏反应的原因。然而，她还出现了血管性水肿、孤立性风团和喉部水肿；因此，IgE介导的I型超敏反应也可能与固定性药疹同时发生。
我们报告了一名患者被诊断为由厄多司坦同时诱发的两种不同超敏反应。我们还证明患者可能同时出现多种症状，这些症状通常源于不同超敏机制的重叠。医生应意识到，一些对某些药物过敏的患者可能同时出现由不同超敏反应机制引起的多种症状。
