Allergy Asthma Immunol Res.  2019 Mar;11(2):231-240. 10.4168/aair.2019.11.2.231.

Eperisone-Induced Anaphylaxis: Pharmacovigilance Data and Results of Allergy Testing

• Park KH
• Lee SC
• Yuk JE
• Kim SR
• Lee JH
• Park JW

• KMID: 2431855
• DOI: http://doi.org/10.4168/aair.2019.11.2.231

Abstract

PURPOSE
Eperisone is an oral muscle relaxant used in musculoskeletal disorders causing muscle spasm and pain. For more effective pain control, eperisone is usually prescribed together with nonsteroidal anti-inflammatory drugs (NSAIDs). As such, eperisone may have been overlooked as the cause of anaphylaxis compared with NSAIDs. This study aimed to analyze the adverse drug reaction (ADR) reported in Korea and suggest an appropriate diagnostic approach for eperisone-induced anaphylaxis.
METHODS
We reviewed eperisone-related pharmacovigilance data (Korea Institute of Drug Safety-Korea Adverse Event Reporting System [KIDS-KAERS]) reported in Korea from 2010 to 2015. ADRs with causal relationship were selected. Clinical manifestations, severity, outcomes, and re-exposure information were analyzed. For further investigation, 7-year ADR data reported in a single center were also reviewed. Oral provocation test (OPT), skin prick test (SPT) and basophil activation test (BAT) were performed in this center.
RESULTS
During the study period, 207 patients had adverse reactions to eperisone. The most common ADRs were cutaneous hypersensitive reactions (30.4%) such as urticaria, itchiness or angioedema. Fifth common reported ADR was anaphylaxis. There were 35 patients with anaphylaxis, comprising 16.9% of the eperisone-related ADRs. In the single center study, there were 11 patients with eperisone-induced anaphylaxis. All the patients underwent OPT and all the provoked patients showed a positive reaction. Four of the 11 patients with anaphylaxis also underwent SPT and BAT, which were all negative.
CONCLUSIONS
Incidence of eperisone-induced anaphylaxis calculated from the KIDS-KAERS database was 0.001%. Eperisone can cause hypersensitive reactions, including anaphylaxis, possibly by inducing non-immunoglobulin E-mediated immediate hypersensitivity.

Keyword

Adverse drug reaction; anaphylaxis; eperisone; hypersensitivity; non-steroidal anti-inflammatory agents

MeSH Terms

Anaphylaxis*
Angioedema
Anti-Inflammatory Agents, Non-Steroidal
Basophils
Drug-Related Side Effects and Adverse Reactions
Humans
Hypersensitivity*
Hypersensitivity, Immediate
Incidence
Korea
Pharmacovigilance*
Skin
Spasm
Urticaria
Anti-Inflammatory Agents, Non-Steroidal

Figure

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  Fig. 1 Study design schematic. KIDS-KAERS, Korea Institute of Drug Safety-Korea Adverse Event Reporting System; ADR, adverse drug reaction.

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  Fig. 2 Number of prescriptions for eperisone and ADRs during 6 years. ADR, adverse drug reaction.

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  Fig. 3 Chemical structures of eperisone and related compounds.

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