Chlorpheniramine-induced anaphylaxis diagnosed by basophil activation test

Abstract

Chlorpheniramine is a widely prescribed H1-antihistamine for relieving urticaria or histamine-mediated allergic reactions. However, although rare, it may cause immediate hypersensitivity reactions. The diagnosis is usually made by provocation test, but its application is often limited due to comorbidities or potential risk of severe reactions. In those cases, skin tests and basophil activation tests can be considered as additional diagnostic tests for the drug allergy. Here, we report a 33-year-old female with underlying chronic urticaria, who recurrently developed anaphylaxis after chlorpheniramine administration. Intradermal test showed positive responses in the patient at 0.02 mg/mL of chlorpheniramine, but not in healthy controls. Basophil activation test showed significant up-regulation of CD63 and CD203c by chlorpheniramine. The present case reminds the rare but potential allergic risk of chlorpheniramine, and also suggests the potential utility of basophil activation test in making the diagnosis.

Keywords: Anaphylaxis; Basophils; Drug Hypersensitivity.

Fig. 1. Basophil activation tests with chlorpheniramine. The bar results indicate the percentage of basophil activation markers CD63/CD203c after stimulation with positive control (anti-FcεRI monoclonal antibody), negative control (buffer), chlorpheniramine, carrier protein, or chlorpheniramine conjugated with carrier protein.