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Contact allergy to ophthalmic dipivalyl epinephrine hydrochloride: demonstration by patch testing
Author(s) -
Gaspari Anthony A
Publication year - 1993
Publication title -
contact dermatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.524
H-Index - 96
eISSN - 1600-0536
pISSN - 0105-1873
DOI - 10.1111/j.1600-0536.1993.tb03321.x
Subject(s) - medicine , contact allergy , allergy , epinephrine , dermatology , contact dermatitis , patch test , patch testing , allergic contact dermatitis , anesthesia , immunology
A patient presented with a 3‐month history of conjunctivitis and periocular eczema. He had a 3‐year history of glaucoma and was being treated with 3 different locally applied eyedrops (Timoptic (timolol maleate) ophthalmic solution 0.25%, Pilocar (pilocarpine) ophthalmic solution 1%. and Propine (dipivalyl epinephrine hydrochloride) ophthalmic solution 0.1%). Patch testing with all 3 undiluted eyedrop solutions revealed a reaction only to Propine eyedrops. Patch testing to the individual components of Propine eyedrops revealed an allergic reaction to 0.5%, dipivalyl epinephrine hydrochloride that was apparent on the 2nd patch test reading. After discontinuing the Propine eyedrops, the conjunctivitis as well as the periocular dermatitis resolved, proving that the positive patch tests were relevant to both. It was reported that re‐exposure to dipivalyl epinephrine hydrochloride by intra‐ocular challenge was necessary to diagnose this allergy. This is the first demonstration of dipivalyl epinephrine hydrochloride allergy by patch testing. Since the 1st patch test reading (2 days) was weak. 2nd patch test (4 days) readings may be important in diagnosing this allergy by patch testing.