Two male patients A and B, diagnosed with inflammatory bowel disease who developed generalized urticaria after several months of treatment with a desktop.
In case A, a 31-year-old man presented with generalized urticaria after two months of tapering, as well as previous urticaria and angioedema reactions after aspirin administration (aspirin acid).
Case B, 30 years old, presented with generalized maculopapular rash after three months of treatment with tapering.
Six months later, treatment was restarted with tape, although she had introduced oral and rectal budesonide three months earlier.
After another three months of treatment with all the above and two weeks after withdrawal of corticosteroids, the patient developed generalized urticaria.
Skin tests
Skin tests were performed according to the recommendations of the European Academy of Allergology and Clinical Immunology (EAACI) (5).
Prick at 1/10 and 1/1 using a specially prepared table (10 mg/ml Claazo®)
Histamine at 1/10 and 1/1 was used as positive control.
Saline prick serum was used as negative control.
Results are considered negative when the papule obtained is < or equal to 3 mm or less than histamine.
Prick tests were performed in 10 healthy patients not previously exposed to 5-ASA.
Single-blind placebo-controlled oral challenge
After taking a placebo, increasing doses of the drug involved in a reaction are given for a certain time, starting with the desired dose for the treatment, which has been maintained since then.
Diseases or treatments that contraindicate the use of medication, or uncontrolled diseases (hypertension, diabetes) should be ruled out.
Signaling that may interfere with test results (corticosteroids, antihistamines, etc.)
If reactions occur during administration, such as urticaria, angioedema, etc., you are given the appropriate treatment to reverse them in each case and the challenge is stopped.
Establishment plan
Written informed consent was requested from the patient for skin and oral challenge tests.
The outpatient management protocol developed in our Allergy Service was implemented as shown in Table I.
In case B, budesonide was suspended in enema 7 days before initiating withdrawal symptoms.
This protocol administers increasing doses (mg) of the desktop with several daily doses in 17 days, with a time interval increasing every day, 1 hour and 8 hours.
Doses are given until the patient tolerates the therapeutic dose required.
Table I shows the daily cumulative dose (the sum of milligrams per patient up to that moment).
On the 17th day, 1000 mg tablets are finally administered as a package leaflet (3,000 mg per day).
Prick on 1/10 and on both patients and controls had negative results on the Symptom Checklist and Path Signal.
Oral provocation in patient A with acetylsalicylic acid up to 500 mg, with localized urticaria on the face.
a To avoid the appearance of symptoms developed in a follow-up unit of 17 days, with 1000 mg of symptoms every 8 hours (3,000 mg per day) in patients A and B. From then on, patients maintained adequate doses for six months
