Asia Pac Allergy.  2016 Oct;6(4):253-256. 10.5415/apallergy.2016.6.4.253.

Bepotastine-induced urticaria, cross-reactive with other antihistamines

• Kang JW
• Lee J

• KMID: 2397022
• DOI: http://doi.org/10.5415/apallergy.2016.6.4.253

Abstract

Second-generation antihistamines are widely prescribed for the control of symptoms of allergic inflammation such as itchy hives, coryza, and itchy eyes. In rare circumstances, these drugs might provoke allergic inflammation. Hypersensitivity to bepotastine besilate, a second-generation antihistamine has never been reported. A 17-year-old schoolgirl, whose paroxysmal itchy hives had been controlled with bepotastine, experienced aggravation of the hives. An oral provocation test confirmed her hypersensitivity to bepotastine and cross-reactivity to levocetirizine. She showed no reaction to chlorpheniramine, ketotifen, or olopatadine among the 13 antihistamines tested. While searching for an antihistamine to control her itchy hives, we found that she also exhibited cross-reactivity to various antihistamines with different chemical structures from that of bepotastine, which is not predicted according to the chemical classification of antihistamines. We report a case of hypersensitivity to bepotastine besilate in a patient with chronic spontaneous urticaria.

Keyword

Histamine antagonists; Urticaria; Drug hypersensitivity; Cross-reactions

MeSH Terms

Adolescent
Chlorpheniramine
Classification
Drug Hypersensitivity
Histamine Antagonists*
Humans
Hypersensitivity
Inflammation
Ketotifen
Olopatadine Hydrochloride
Urticaria*
Chlorpheniramine
Histamine Antagonists
Ketotifen
Olopatadine Hydrochloride

Figure

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  Fig. 1 The patient's right forearm. Itchy hives over the entire body were noted after an oral provocation with bepotastine besilate.

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  Fig. 2 The actual feature of intradermal tests with various kinds of antihistamines. N indicates negative control, and the actual size of bleb after intradermal injection was marked as the circles. Each number indicates an intradermally injected antihistamine.

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