Anaphylaxis to levetiracetam in an adolescent: a very rare occurence

Background. Antiepileptic drugs (AEDs) are among the most common causes of severe delayed-type hypersensitivity reactions such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and Drug Reaction with Eosinophilia and Systemic Symptoms(DRESS) in children. These reactions are more commonly seen with aromatic AEDs such as phenytoin and carbamazepine than the non-aromatic or new generation AEDs. However immediate-type hypersensitivity reactions such as urticaria/angioedema, anaphylaxis are very rare with AEDs. Case. Levetiracetam is an increasingly used new non-aromatic antiepileptic drug and reported to have a better safety profile in daily practice. We present the first adolescent case who developed an anaphylactic reaction with intravenous levetiracetam, not reported in this age group before in the literature. Conclusion. Hypersensitivity reactions in the form of anaphylaxis can be rarely observed with new generation AEDs. Therefore, when any antiepileptic drug is started on any patient, immediate type serious reactions such as anaphylaxis should be kept in mind, not only focusing on delayed reactions such as SJS, TEN,or DRESS

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1. Kuyucu S, Caubet JC. Hypersensitivity reactions to antiepileptic drugs in children: epidemiologic, pathogenetic, clinical, and diagnostic aspects. J Allergy Clin Immunol Pract 2018; 6: 1879-1891.e1.

2. Chung AM, Eiland LS. Use of second-generation antiepileptic drugs in the pediatric population. Paediatr Drugs 2008; 10: 217-254.

3. Levy ZD, Slowey M, Schulder M. Acute generalized exanthematous pustulosis secondary to levetiracetam and valproic acid use. Am J Emerg Med 2017; 35: 1036.e1-1036.e2.

4. Bayram AK, Canpolat M, Çınar SL, et al. Drug reaction with eosinophilia and systemic symptoms syndrome induced by levetiracetam in a pediatric patient. J Emerg Med 2016; 50: e61-e66.

5. Dar WR, Sofi N, Latief M, Dar IA, Kasana BA. Levetiracetam induced drug reaction with eosinophilia and systemic symptom syndrome. Indian J Dermatol 2016; 61: 235.

6. Kim HK, Kim DY, Bae EK, Kim DW. Adverse skin reactions with antiepileptic drugs using Korea adverse event reporting system database, 2008-2017. J Korean Med Sci 2020; 35: e17.

7. Koklu E, Ariguloglu EA, Koklu S. Levetiracetaminduced anaphylaxis in a neonate. Pediatr Neurol 2014; 50: 192-194.

8. Alkhotani A, McLachlan RS. Levetiracetam induced angioedema in a patient with previous anticonvulsant hypersensitivity reaction to phenytoin and lamotrigine. Seizure 2012; 21: 407- 408.

9. Ortega-Camarero MA, Avila R, Prados Castaño M, Piñero M, Quiralte J, Cimbollek S. Challenge-based pregabalin induced urticaria and angioedema. A case report. Allergol Immunopathol (Madr) 2012; 40: 323.

10. Polat I, Karaoglu P, Ayanoglu M, Yis U, Hiz S. Lifethreatening and rare adverse effects of phenytoin. Pediatr Emerg Care 2015; 31: e3.

11. Duke JD, Ryan PB, Suchard MA, et al. Risk of angioedema associated with levetiracetam compared with phenytoin: findings of the observational health data sciences and informatics research network. Epilepsia 2017; 58: e101-e106.

12. Demoly P, Adkinson NF, Brockow K, et al. International Consensus on drug allergy. Allergy 2014; 69: 420-437.

13. Chung CH, Mirakhur B, Chan E, et al. Cetuximabinduced anaphylaxis and IgE specific for galactosealpha-1,3-galactose. N Engl J Med 2008; 358: 1109- 1117.

14. Vanhaelen M, Duchateau J, Vanhaelen-Fastré R, Jaziri M. Taxanes in taxus baccata pollen: cardiotoxicity and/or allergenicity? Planta Med 2002; 68: 36-40.

15. Jain SS, Green S, Rose M. Anaphylaxis following intravenous paracetamol: the problem is the solution. Anaesth Intensive Care 2015; 43: 779-781.

16. Shiny TN, Mahajan VK, Mehta KS, Chauhan PS, Rawat R, Sharma R. Patch testing and cross sensitivity study of adverse cutaneous drug reactions due to anticonvulsants: a preliminary report. World J Methodol 2017; 7: 25-32.

17. Demoly P, Bousquet J. Epidemiology of drug allergy. Curr Opin Allergy Clin Immunol 2001; 1: 305-310.

Turkish Journal of Pediatrics-Cover
  • ISSN: 0041-4301
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 1958
  • Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
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