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Description of key information

Four case reports on the sensitizing properties of pseudoephedrine were identified. In these studies postive patch testing showed that these patients where sensitized to pseudoephedrine.

Additional information

Four case reports on the sensitizing properties of pseudoephedrine were identified. In these studies postive patch testing showed that these patients where sensitized to pseudoephedrine.

In a case report (Downs 1998) sensitization to prilocaine and lignocaine may have occurred in a patient following the topical application of Emla cream to an already inflamed skin site. Several months later application of pseudoephidrine resulted in palpitations and a generalised red itchy eruption. Patch testing showed positive reactions to pseudoephedrine, lignocaine and prilocaine. The presence of a benzene ring and a distally-placed nitrogen molecule, surrounded by methyl groups, in lignocaine, prilocaine and pseudoephedrine, suggests some sharing of epitopes between all 3 chemicals. Therefore, sensitization to pseudoephedrine may be due to crosssensitization.

A case of pseudoephedrine-induced Acute Generalized Exanthematous Pustulosis (AGEP) is described (Mayo-Pampin 2006). 24-hours before admission to the hospital the patient ingested one tablet Rinoebastel containing ebastine (10 mg) and pseudoephedrine (120 mg). A patch test showed an intense positive result (++++) at 48 and 96 hours with Rinoebastel 2,5% and 5% in petrolatum, as well as with pseudoephedrine 1% in petrolatum. Epicutaneous tests with ebastinc 1 % and 2% in petrolaturn were negative.

In a case report, a 42 -year old woman had an adverse drug reaction to Vincigrip containing paracetamol, pseudoephedrine, chlorphenamine and several excipients (Padial 2003). Patch testing with both the commercial preparation Vincigrip and pseudoephedrine showed an intense positive result at 48 h, with erythema and papules that persisted for 96 h but the epicutaneous tests with other sympathomimetic drugs were negative. A biopsy of the positive epicutaneous reaction site with pseudoephedrine was performed and the mononuclear infiltrate was composed mainly of CD4+ T cells, although CD8+ lymphocytes were also present in significant numbers. Furthermore, there was also a strong positive staining for CD25 and CD45RO. A lymphocyte proliferation assays were performed in which peripheral blood mononuclear cells from the patient were cultured in the presence of different doses of pseudoephedrine and other sympathomimetic drugs. After 5 days of culture no specific cell proliferation was detected in response to pseudoephedrine or the different drug analogues tested.

A 44-year-old Caucasian woman was admitted with an acute generalized, blistering, erythrodermic dermatitis. 6 h prior to admission, she had taken a combination of acrivastine and pseudoephedrine hydrochloride (Benadryl Plus) (Millard 2003). A patch testing revealed an allergic reaction after 48 hours with Benadryl Plus, but no reaction to Benadryl and to the blue and white components of the Benadryl Plus capsule.