RESUMO
Ophthalmologists frequently use mydriatics both for diagnosis (retinal exploration, refraction tests) and for treatment. Cyclopentolate is used to induce quick and successful mydriasis for pediatric eye examination. Hypersensitivity reaction to cyclopentolate is very uncommon, especially in children. We report the case of a child who experienced a hypersensitivity reaction to cyclopentolate during preparation for an eye examination under cycloplegia.
Assuntos
Alérgenos/administração & dosagem , Ciclopentolato/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Midriáticos/efeitos adversos , Soluções Oftálmicas/administração & dosagem , Alérgenos/imunologia , Anafilaxia , Pré-Escolar , Ciclopentolato/administração & dosagem , Ciclopentolato/química , Ciclopentolato/imunologia , Diagnóstico Diferencial , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/fisiopatologia , Dispneia , Edema , Epinefrina/administração & dosagem , Humanos , Imunização , Masculino , Midriáticos/administração & dosagem , Midriáticos/química , Midriáticos/imunologia , Soluções Oftálmicas/análise , Testes CutâneosRESUMO
INTRODUCTION: Sympathomimetic (alpha-adrenergic) drugs are mainly used because of their vasoconstrictor properties, for nasal congestion, or as mydriatics. Although sympathomimetic drugs are used often, allergic reactions are rare, especially when the drugs are administered systemically. Cross-reactivity may exist among catecholamine derivatives, although reported data on this are contradictory. In this study, we investigate if there is cross-reactivity in patch tests among these drugs. MATERIAL AND METHODS: Patch tests with 10% phenylephrine and 10% pseudoephedrine in petrolatum, and 10% and 20% ephedrine, 10% phenylpropanolamine, 5% fepradinol, 1% methoxamine, and 10% oxymetazoline, all administered in dimethyl sulfoxide (DMSO), were carried out in 14 patients with a history of allergy to any of these drugs. DMSO was used as the negative control. RESULTS: All patients except one (patient number five) showed positive patch-test reactions to at least two different drugs. Nine patients (64.3%) were cross-sensitized to three or more different drugs, and 57.1% of patients were sensitized to four or more sympathomimetic drugs. Patients who experienced generalized rashes caused by orally administered pseudoephedrine had a stronger response and more cross-reactivity with other sympathomimetic drugs in patch tests than those who experienced local contact dermatitis. CONCLUSIONS: We conclude that there is cross-reactivity among the different sympathomimetic drugs tested, especially if the drug is administered systemically.
