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Fixed drug eruption (FDE) is a well-recognized, non-immediate, drug hypersensitivity reaction, often attributed to the use of various medications, most commonly non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics. Cross-reactivity between related NSAIDs in FDE has been reported, but among chemically unrelated NSAIDs, is rare. Herein, we present a rare well-documented case where a patient initially displayed tolerance to etoricoxib after experiencing a nimesulide-induced FDE. Subsequently, the patient developed an etoricoxib-induced FDE, accompanied by the development of bullous lesions. This case report and the literature review on comparable FDE occurrences shed light on the intricate nature of FDEs, suggesting the possibility of cross-reactivity between chemically related and unrelated NSAIDs or the emergence of new drug-specific T cells without cross-reactivity after multiple exposures to a drug in a susceptible patient. Our case underscores the importance of increased awareness and vigilance among both physicians and patients in the realm of personalized medicine. Further research is needed to unravel the intricate mechanisms behind these drug eruptions, improve diagnostic approaches, and enhance patient care. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti‐inflammatory drugs (NSAIDs) are among the main causes of fixed drug eruption (FDE). Cross‐sensitivity between chemically unrelated NSAIDs has been rarely described in FDE. We report herein two cases of NSAID‐induced FDE confirmed by oral provocation test (OPT) with a literature review. Case 1 is a 49‐year‐old woman who took mefenamic, naproxen and acetaminophen for lumbago. On the second day, she noticed three erythematous plaques, located in the upper lip, chin and the right hand, which faded spontaneously, leaving residual patches. Three months later, she took mefenamic acid with reactivation of the same plaques. She received naproxen. On the same day, she exhibited a reactivation of lesions with the development of a new one. These lesions have disappeared leaving hyperpigmented sequelae. After negative patch test to naproxen, an OPT was performed with positive reaction, observed on the third day. To establish the cross‐reactivity, she underwent OPTs, which gave positive results to indomethacin, ketoprofen and tiaprofenic acid. Case 2 is a 52‐year‐old woman who presented painful dusky‐red macules, located in the right and left wrists, 24 hours after taking mefenamic acid. She described two similar events that occurred in the past with an undefined drug and piroxicam. Patch tests to lysine acetylsalicylate, mefenamic acid, piroxicam, naproxen and celecoxib were negative. OPTs to the same NSAIDs gave positive results to lysine acetylsalicylate, piroxicam and mefenamic acid. Thirteen case reports, seven case series and one retrospective analysis, including cases with confirmed cross‐reactivity between NSAIDs, were reported in literature. Clinicians should be aware of such phenomenon. [ABSTRACT FROM AUTHOR]

Drug reaction with eosinophilia and systemic symptom (DRESS) is a severe adverse drug‐induced reaction. Commonly related to anticonvulsant and allopurinol, DRESS can affect both adults and children. Cefotaxime is rarely associated with DRESS, especially with children. We report a cefotaxime‐induced DRESS in a child and emphasize the role of allergological work‐up to point out the culprit drug in exploring cross‐reactivity and identifying a possible cosensitization. A 2‐year‐old boy was treated with cefotaxime, vancomycin and metronidazole for acute otomastoiditis. Metronidazole was withdrawn and vancomycin was changed by teicoplanin 10 and 15 days later, respectively. Nineteen days after ongoing cefotaxime and 4 days after teicoplanin intake, the patient developed hyperthermia, a widespread exanthema, facial oedema with neither mucosal involvement nor palpable lymphadenopathy. Biological tests revealed eosinophilia, atypical lymphocytes, mild cytolysis and a high lactate dehydrogenase level. Serological tests for viral and bacterial infections were negative. DRESS was suspected and the 2 antibiotics were withdrawn. Intradermal tests (IDT) were carried out 2 months later with cefotaxime and teicoplanin. They revealed a positive result at 48‐hour reading. To assess cross‐reactivity among β‐lactams, IDT to penicillins (benzylpenicillin, amoxicillin and oxacillin) was performed showing negative results at 48‐hour reading. Nevertheless, IDT to cephalosporins (cefazolin, cefuroxime, ceftazidime and ceftriaxone) displayed positive results at 48‐hour reading. As a result, IDT are of great interest and should be performed to confirm the role of cefotaxime and detect a potential cross‐reactivity with chemically similar drugs and drugs taken before and during the episode of DRESS. [ABSTRACT FROM AUTHOR]

We report a 26-year-old female patient who developed anaphylaxis after the use of pantoprazole and esomeprazole and was successfully desensitized with rabeprazole. The patient, who was diagnosed with duodenal ulcer by gastroscopy, was prescribed pantoprazole 40 mg tablet for treatment. Thirty minutes after taking the first dose of pantoprazole, generalized urticaria, angioedema of the lips, abdominal pain, diarrhea, shortness of breath and hypotension (blood pressure: 80/40 mmHg) developed. No loss of consciousness developed. Since dyspeptic complaints continued, esomeprazole 40 mg tablet was prescribed to the patient 1 month later. Generalized urticaria, abdominal pain, diarrhea and dyspnea developed 40 minutes after taking the first dose of esomeprazole. As hypersensitivity to PPIs was considered, skin tests were performed with all PPIs to detect alternative PPIs, as skin tests are safe and specific. A positive reaction was detected to all PPIs in the skin tests, so no oral provocation was performed with PPIs. Desensitization was planned because treatment with PPI was necessary and there was no alternative treatment. This patient who developed anaphylaxis with pantoprazole and esomeprazole was successfully desensitized with rabeprazole. In conclusion, in cases of hypersensitivity to PPIs, the possibility of cross-reactivity should be kept in mind and skin tests with PPIs should be performed before performing oral provocation testing. If no alternative is found, a PPI desensitization protocol can be applied. [ABSTRACT FROM AUTHOR]

Beta-lactam antibiotics are the most commonly reported drug allergy in adults and children. More than 95% of those with reported allergy labels to beta lactams are not confirmed when subjected to allergy testing. Beta lactam antibiotics are associated with a wide spectrum of immediate and delayed drug hypersensitivity reactions. The latency period to symptoms and clinical presentation aids in the causality assessment. Risk stratification based on diagnosis and timing then allows for appropriate management and evaluation. Skin prick testing, intradermal testing and oral challenge are well established for evaluation of immediate reactions. Delayed intradermal testing, patch testing and oral challenge can also be considered for evaluation of mild to moderate delayed reactions. Cross-reactivity between beta-lactams appears to be driven most commonly by a shared R1 side-chain. Standardized algorithms, protocols and pathways are needed for widespread implementation of a pragmatic and effective approach to patients reporting beta lactam allergy. [ABSTRACT FROM AUTHOR]