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Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Case Report

Immediate Reaction to Propranolol: An Extremely Rare but Important Condition. A Case Report

Author(s): Lucía González-Bravo*, María-José Sánchez-González, José Barbarroja-Escudero, Josefa Monjo-Paz, Dorotea Matas-Dominguez and Melchor Alvarez-Mon

Volume 19, Issue 2, 2024

Published on: 08 May, 2023

Page: [303 - 305] Pages: 3

DOI: 10.2174/1574886318666230417103423

Price: $65

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Abstract

Introduction: Beta-blockers involve a group of drugs widely used nowadays. Propranolol was the first beta-blocker available in the market. It is the most prescribed first-generation betablocker and is commonly used. Beta-blocker allergy is extremely unusual. Only an isolated case of an urticaria reaction to propranolol has been published in 1975.

Case Presentation: We present a 44-year-old man. In 2016, he was treated with a daily dose of 5 mg of propranolol prescribed for a diagnosis of essential tremor. On the third day of medical treatment, he experienced an episode of generalized urticaria directly related to the administration of propranolol. He continued with his habitual treatment and he had no other urticaria episodes. A drug provocation test was carried out with gradually increasing doses of the culprit drug. Thirty minutes after a total cumulative dose of 5 mg, the patient had several hives on the chest, abdominal region and arms. Two weeks later, a new drug provocation test was performed to bisoprolol as an alternative beta-blocker, with good tolerance.

Conclusion: We describe a new case of urticaria secondary to propranolol, presenting as an immediate hypersensitivity reaction. Bisoprolol has been succesfully proved to be a safe option. Bisoprolol is a second-generation beta-blocker, it is available and commercialized worldwide, which makes it a good alternative.

Keywords: Beta-blocker, propranolol, allergy, immediate-reaction, bisoprolol, ACE.

[1]
Ogrodowczyk M, Dettlaff K, Jelinska A. Beta-blockers: Current state of knowledge and perspectives. Mini Rev Med Chem 2015; 16(1): 40-54.
[http://dx.doi.org/10.2174/1389557515666151016125948] [PMID: 26471965]
[2]
Seides SF, Raskin JN, Damato AN. Propranolol-induced urticaria: Successful therapy with tolamolol. Chest 1975; 67(4): 496-7.
[http://dx.doi.org/10.1378/chest.67.4.496] [PMID: 1173060]
[3]
Jensen HA, Mikkelsen HI, Wadskov S, Sondergaard J. Cutaneous reactions to propranolol (Inderal). Acta Med Scand 1976; 199(5): 363-7.
[PMID: 132088]
[4]
Lee S, Hess EP, Nestler DM, et al. Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis. J Allergy Clin Immunol 2013; 131(4): 1103-8.
[http://dx.doi.org/10.1016/j.jaci.2013.01.011] [PMID: 23453138]
[5]
Coop CA, Schapira RS, Freeman TM. Are ace inhibitors and beta-blockers dangerous in patients at risk for anaphylaxis? J Allergy Clin Immunol Pract 2017; 5(5): 1207-11.
[http://dx.doi.org/10.1016/j.jaip.2017.04.033] [PMID: 28552379]
[6]
Hopfner F, Deuschl G. Managing essential tremor. Neurotherapeutics 2020; 17(4): 1603-21.
[http://dx.doi.org/10.1007/s13311-020-00899-2] [PMID: 32915385]
[7]
Stephen SA. Unwanted effects of propranolol. Am J Cardiol 1966; 18(3): 463-72.
[http://dx.doi.org/10.1016/0002-9149(66)90071-3] [PMID: 4224228]
[8]
Almeyda J, Levantine A. Cutaneous reactions to cardiovascular drugs. Br J Dermatol 1973; 88(3): 313-9.
[http://dx.doi.org/10.1111/j.1365-2133.1973.tb07558.x] [PMID: 4145887]
[9]
Brockow K, Ardern-Jones MR, Mockenhaupt M, et al. EAACI position paper on how to classify cutaneous manifestations of drug hypersensitivity. Allergy 2019; 74(1): 14-27.
[http://dx.doi.org/10.1111/all.13562] [PMID: 30028512]
[10]
Wood AJJ, Feely J. Pharmacokinetic drug interactions with propranolol. Clin Pharmacokinet 1983; 8(3): 253-62.
[http://dx.doi.org/10.2165/00003088-198308030-00004] [PMID: 6342901]
[11]
Gomez HJ, Cirillo VJ, Irvin JD. Enalapril. Drugs 1985; 30(S1): 13-24.
[http://dx.doi.org/10.2165/00003495-198500301-00004] [PMID: 2994984]

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