Reactions 1002 - 22 May 2004

★ SLoperamide

First report of anaphylaxis in a child: case reportA 10-year-old boy developed anaphylaxis after receiving oral

loperamide 2mg for acute gastroenteritis. He had previouslyreceived loperamide without experiencing any adverse effects.

Five minutes after receiving the dose of loperamide, the boydeveloped nasal congestion, rhinorrhoea, dyspnoea,wheezing, cough, cyanosis of the lips, oedema of the righteyelid and a generalised erythematous macular eruption. Hewas treated with parenteral antihistamines and corticosteroidsand improved within 2–3hours.

One year after the episode of anaphylaxis, the boyunderwent skin prick and intradermal testing. Skin prick testswith loperamide 2 mg/mL and other pethidine [meperidine]derivatives (pethidine, fentanyl and alfentanil) were allnegative. Intradermal tests were positive with loperamide0.02 mg/mL, but were negative for other pethidine derivatives.

Author comment: "The clinical history, the previousadministration of loperamide with no ill-effects and theresults of intradermal tests suggest an immunoglobulin E-mediated process."Perez-Calderon R, et al. Anaphylaxis due to loperamide. Allergy 59: 369-370, No.3, Mar 2004 - Spain 800974202

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of anaphylaxis associatedwith loperamide. The WHO Adverse Drug Reaction databasecontained nine reports of anaphylactic shock and 21 reports ofanaphylactoid reaction associated with loperamide.

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Reactions 22 May 2004 No. 10020114-9954/10/1002-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved