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Inicio Allergologia et Immunopathologia Allergic contact blepheroconjunctivitis with phenylephrine eyedrops ­the releva...
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Vol. 35. Issue 4.
Pages 157-158 (July 2007)
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Vol. 35. Issue 4.
Pages 157-158 (July 2007)
DOI: 10.1157/13108227
Allergic contact blepheroconjunctivitis with phenylephrine eyedrops ­the relevance of late readings of intradermal tests
Blefaroconjuntivitis alergica de contacto por colirio de fenilefrina. Relevancia de la lectura tardía de las pruebas intradermicas
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C. Botelhoa, J. Rodriguesa, MG. Castel Brancoa
a Service of Immune-Allergology. Hospital S. João, E.P.E, Porto, Portugal
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Table. I Results of skin prick, intradermal and patch tests
Allergic reactions to midriatic eyedrops are rare despite extensively used by ophthalmologists. Phenylephrine is responsible for 54-95 % of cases reported in literature. We present the case of a 56-year-old man with blepharoconjunctivitis after instillation of phenylephrine 5 %, tropicamide 0.5 %, oxibuprocaine eyedrops. The patient reported good tolerance to the mentioned drugs. Immediate readings of prick and intradermal tests, performed with the suspected drugs, were negative. Late readings (48 and 72 hours) of epicutaneous tests were also negative. At 72 hours, prick and intradermal tests to phenylephrine were positive. Allergic blepharoconjunctivitis to phenylephrine was diagnosed. Phenylephrine is an extensively used midriatic that can act as a potent sensitizing agent and can be the cause of allergic contact reactions in exposed patients. With this case we illustrate the relevance of late readings of intradermal tests in the diagnosis of late hypersensitivity drug reactions. The authors discuss about possible mechanisms responsible for negative results of epicutaneous tests.
Keywords:
phenylephrine, eyedrops, allergic blepharoconjunctivitis
Las reacciones alérgicas por colirios midriáticos son raras, a pesar de lo ampliamente usados por los oftalmólogos. La fenilefrina es responsable del 54-95% de los casos publicados. Presentamos el caso de un varón de 56 años, con blefaroconjuntivitis tras la instilación de un colirio compuesto de fenilefrina 5%, tropicamida 0,5% y oxibruprocaina. El paciente había tolerado anteriormente estos medicamentos. La lectura inmediata de las pruebas cutáneas (prick e intradermo) efectuadas con esos medicamentos, fue negativa. La lectura tardía (48 y 72 horas) de los tests epicutáneos también fue negativa. A las 72 horas, la prueba con fenilefrina, tanto el prick como la intradérmica, fue positiva. Por ello, el diagnóstico fue blefaroconjuntivitis alérgica por fenilefrina. La fenilefrina es una midriático ampliamente usado que puede actuar como agente sensibilizante, causando reacciones alérgicas de contacto en los pacientes expuestos. Este caso ilustra sobre la relevancia de la lectura tardía de las pruebas cutáneas para el diagnóstico de las reacciones tardías de hipersensibilidad. Se discuten los posibles mecanismos responsables de los resultados negativos de las pruebas epicutáneas.

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