Fixed Drug Eruption to Levocetirizine Detected by Patch Testing
Abstract
Dear Editor, Fixed drug eruption [FDE] is a cutaneous adverse reaction due to type IV [delayed cell mediated] hypersensitivity, recurs at the same site and resolves spontaneously after discontinuation of the causative drugs with residual hyperpigmentation.[1] Many drugs have been implicated, but FDE with levocetirizine and diagnosis by patch testing is rare.[2] Here we report a 11-year-old boy who was tested positive to levocetirizine by patch testing. An 11-year-old boy gave a history of four episodes of FDE to multiple drugs after taking the medications for upper respiratory tract infection. His last episode was three years back. List of drugs implicated was noted down and patch test was done with implicated drugs like ofloxacin, cefixime, cefuroxime, paracetamol and levocetirizine. Levocetirizine was the common drug taken by the patient during each episode. Implicated drugs were taken, crushed and mixed with petrolatum, applied “as is” on aluminium finn chamber and occluded for 24/48 hours in the pigmented site [involved site]. The readings were performed on day 2 and day 4 according to the criteria of International Contact Dermatitis Research Group.[2] Patch test was positive for levocetirizine (+) in the involved site and negative for all other drugs. To detect cross-reaction, patch test was repeated with hydroxyzine, cetirizine and levocetirizine “as is” on both involved and uninvolved sites. On day 2 and day 4, the readings for all three drugs were (++) in involved…
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