Reactions 1463, p8 - 3 Aug 2013

SAmoxicillin/clavulanic acid

Erythroderma, angioedema and rhino-conjuncivitisin a child: case report

A 4-year-old boy developed diffuse macular erythrodermawhile receiving amoxicillin/clavulanic acid, and subsequentlydeveloped diffuse macular erythroderma while receivingamoxicillin at 10 years of age, as well as angioedema andrhino-conjunctivitis during an oral provocation test withamoxicillin [dosages not stated; some indications and routesnot stated].

The boy developed diffuse macular erythroderma the dayafter starting amoxicillin/clavulanic acid at age 4 years. At age6 years, he received a course of amoxicillin. At age 10 years, hedeveloped diffuse macular erythroderma again the day afterstarting amoxicillin/clavulanic acid. Two months later, prick,patch and intradermal tests to amoxicillin and amoxicillin/clavulanic acid as well as specific IgE dosage to amoxicillinwere all negative. A basophil activation test with amoxicillinwas compatible with a no-responder result. An oralprovocation test with amoxicillin/clavulanic acid was positive,with erythroderma localised to the hands and feet the day afterreceiving the first dose.

The boy received cetirizine, and his symptoms resolved.One week later, an oral provocation test with amoxicillin for5 days was well tolerated. A possible delayed allergy toclavulanic acid was suspected. After 6 months, he received anoral course of amoxicillin for otitis. After receiving one dose ofamoxicillin, he developed a similar cutaneous reaction. An oralprovocation test with amoxicillin/clavulanic acid resulted in amild reaction with erythroderma only. Six weeks later, an oralprovocation test with amoxicillin resulted in a moderate-severe reaction with angioedema, diffuse erythroderma andrhino-conjunctivitis. He received cetirizine and prednisone,and the reaction resolved.

Author comment: "[Amoxicillin/clavulanic acid] wasadministered at the age of four and ten years old and in bothoccasions this child had a diffuse macular erithrodermia theday after initiation of treatment."Saretta F, et al. Case-report: A pseudo false-negative drug provocation test. Allergy67 (Suppl. 96): 430-431 abstr. 1129, Nov 2012. Available from: URL: http://dx.doi.org/10.1111/all.12036 - Italy 803090914

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Reactions 3 Aug 2013 No. 14630114-9954/13/1463-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved