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Recent Patents on Inflammation & Allergy Drug Discovery

Editor-in-Chief

ISSN (Print): 1872-213X
ISSN (Online): 2212-2710

Research Article

Allergic Contact Dermatitis to Fentanyl TTS with Good Tolerance to Systemic Fentanyl

Author(s): Patricia Rojas-Pérez-Ezquerra*, Sarah Micozzi, Ines Torrado-Español, Ana Rodríguez-Fernández, Vicente Albéndiz-Gutiérrez and Blanca Noguerado-Mellado

Volume 13, Issue 1, 2019

Page: [66 - 68] Pages: 3

DOI: 10.2174/1872213X13666190527105718

Abstract

Background: Fentanyl is primarily an opioid agonist. It is frequently used in general anesthesia as a potent analgesic. It can be administered either orally, transdermally or systemically. Adverse effects due to opium alkaloids are usually because of a non-specific histamine release. Only in a few cases, a true allergy mechanism could be involved. Immediate reactions to opioids are most frequent than delayed reactions. In the past years, delayed reactions have increased in frequency because of the wide use of Transdermal Therapeutic System (TTS) with several opioids for its potent analgesic properties.

Objective: The objective was to study delayed reaction to fentanyl TTS and cross-reactivity with other opioids.

Methods: A 52-year-old man with a diagnosis of pancreatic cancer who began treatment for a bone metastases pain with fentanyl TTS, at a dose of 50 micrograms per hour (mcg/h) is the subject of the study. After 10-15 days of treatment, he developed an itchy papulovesicular rash in the application site of the fentanyl TTS. Afterward, eczema and superficial desquamation just on the application site of the patch were observed. He changed several times the site of application, but always developing the same symptoms in every single application. Later on, he tolerated other opioids such as oral morphine or tramadol. An allergy workout was performed. We performed Patch Tests (PT) with fentanyl at a concentration of 10% in aqua (aq) and with buprenorphine 10% aq., in order to investigate probable crossreactivity among other topical opioids.

Results: Readings were recorded at day 2 (D2) and day 4 (D4), with positive PT only with fentanyl at D2 (+++) and D4 (+++). We decided to perform a single-blind challenge test with buprenorphine 35 mcg/h in TTS, with a negative result. At this moment, fentanyl TTS was replaced by buprenorphine TTS, with good tolerance.

Conclusion: We present the case of Allergic Contact Dermatitis (ACD) due to hypersensitivity to fentanyl with good tolerance to buprenorphine. Positive PT in this patient suggests a type IV hypersensitivity mechanism. Allergic reactions to opioids are frequently immediate, but delayed reactions could appear, especially when the drug is administered topically.

Keywords: Allergic contact, buprenorphine, dermatitis, fentanyl, patch test, transdermal therapeutic system.

[1]
Li PH, Ue KL, Wagner A, Rutkowski R, Rutkowski K. Opioid hypersensitivity: Predictors of allergy and role of drug provocation testing. J Allergy Clin Immunol Pract 2017; 5(6): 1601-6.
[http://dx.doi.org/http://dx.doi.org/10.1016/j.jaip.2017.03.035] [PMID: 28550985]
[2]
Dewachter P, Lefebvre D, Kalaboka S, Bloch-Morot E. An anaphylactic reaction to transdermal delivered fentanyl. Acta Anaesthesiol Scand 2009; 53: 1092-3.
[http://dx.doi.org/http://dx.doi.org/10.1111/j.1399-6576. 2009.02022.x] [PMID: 19496758]
[3]
Musel AL, Warshaw EM. Cutaneous reactions to transdermal therapeutic systems. Dermatitis 2006; 17: 109-22.
[http://dx.doi.org/http://dx.doi.org/10.2310/6620.2006.05051] [PMID: 16956462]
[4]
Bershow A, Warshaw E. Cutaneous reactions to transdermal therapeutic systems. Dermatitis 2011; 22: 193-203.
[PMID: 21781635]
[5]
Pérez-Calderón R, Gonzalo-Garijo MA, Rodríguez-Nevado I. Generalized allergic contact dermatitis from nitroglycerin in a transdermal therapeutic system. Contact Dermat 2002; 46: 303.
[http://dx.doi.org/[http://dx.doi.org/10.1034/j.1600-0536.2002.460513.x]] [PMID: 12084088]
[6]
Vander Hulst K, Parera AE, Jacobs C, Dewulf V, Baeck M, Pujol VRM, et al. Allergic contact dermatitis from transdermal buprenorphine. Contact Dermat 2008; 59: 366-9.
[http://dx.doi.org/[http://dx.doi.org/10.1111/j.1600-0536.2008.01472.x]] [PMID: 19076888]
[7]
Subramanian SV, Shaoling L, Robert MG, Jane S, William WO. W.O. Transdermal administration of fentanyl and analogs thereof. US20180098979A1 (2018).
[8]
Kenneth CL, John EP, Addison BS. Glass having dual protective coatings thereon and method for forming such coatings. US3352708A (1967).
[9]
David L, Juny L, Je PR, Oliver T, Francis C. Transdermal antiemesis delivery system, method and composition therefor. US20070264319A1. (2007).
[10]
Mitsuru K, Toshiro Y. Medicament-containing patch. JP2006169238A 2006.
[11]
Acino AG, Marieke G, Björn S. Transdermal therapeutic system with an overtape comprising two adhesive layers. EP3067050A1 2016.
[12]
Hyun-Suk Y, Young-Moo L, Hyun-Woo K, Hee-Sook K. Formulation for percutaneous administration containing fentanyl and analague thereof. EP2759294B1 (2017).
[13]
Clifford G, Hideo N, David PK. Method for transdermal induction of anesthesia, analgesia or sedation. US5635204A (1997).
[14]
Gary AL, Rama P, Michael JG, Paul DS, Joseph BP, Larry AM. Medtronic Inc. Activity controlled electrotransport drug delivery device. US5213568A (1993).
[15]
Chiou TJ, Liu CY, Tzeng WF, Su YC, Weng YC, Hung CJ, et al. The use of transdermal fentanyl in cancer pain-a compliance study of outpatients in Taiwan. Am J Hosp Palliat Care 2010; 27: 31-7.
[http://dx.doi.org/[http://dx.doi.org/10.1177/1049909109346427]] [PMID: 19801533]

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