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Anaphylaxis to Polyvinylpyrrolidone in Povidone-Iodine for Impetigo Contagiosum in a Boy with Atopic DermatitisYoshida K.a, b · Sakurai Y.a · Kawahara S.c · Takeda T.a · Ishikawa T.b · Murakami T.b · Yoshioka A.a
aDepartment of Pediatrics, Nara Medical University School of Medicine, Kashihara, bDepartment of Pediatrics, Nara City Hospital, Nara, and cDepartment of Pediatrics, Oyodo Hospital, Yoshino, Japan
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Background: Povidone-iodine (PVP-I) is widely used in antiseptic agents. Immediate allergic reaction to PVP-I preparations is very rare and often overlooked, as it is difficult to diagnose. Polyvinylpyrrolidone (PVP) is thought to play a role in the underlying mechanism. We examined the usefulness of the histamine release test (HRT) for definite diagnosis of PVP allergy. Method: A 9-year-old boy with eosinophilia (1,500/µl) and elevated total IgE (1,376 IU/ml) was suspected clinically of having a PVP allergy, as he had anaphylaxis twice when he was administered a PVP-I solution for impetigo contagiosum. Skin prick tests (SPTs) were performed with a PVP-I solution, PVP (K30), gentamicin sulfate and 2 other medicines containing PVP. HRT was assessed using peripheral blood basophils. Results: SPTs to PVP-I solution, PVP-K30 and other medicines were all negative. Histamine release was observed on stimulation by PVP in the presence of autologous serum, although it was not observed in the absence of autologous serum. Conclusions: This observation was in line with the clinical findings that anaphylaxis had not developed despite the long use of PVP-I solution, but developed only when he received PVP-I solution treatment where basophils could contact PVP-I in the presence of serum, which was probably due to a broken skin and vessel condition. Furthermore, our results suggest the usefulness of HRT in the diagnosis of PVP allergy, and the possibility that negative SPT does not entirely rule out PVP allergy.
© 2008 S. Karger AG, Basel
- Schenck HU, Simak P, Haedicke E: Structure of polyvinylpyrrolidone-iodine (povidone-iodine). J Pharm Sci 1979;68:1505–1509.
- Okano M: Irritant contact dermatitis caused by povidone-iodine. J Am Acad Dermatol 1989;20:860.
- Lachapelle JM: Allergic contact dermatitis from povidone-iodine: a re-evaluation study. Contact Derm 2005;52:9–10.
- Nishioka K, Seguchi T, Yasuno H, Yamamoto T, Tominaga K: The results of ingredient patch testing in contact dermatitis elicited by povidone-iodine preparations. Contact Derm 2000;42:90–94.
- Lee SK, Zhai H, Maibach HI: Allergic contact dermatitis from iodine preparations: a conundrum. Contact Derm 2005;52:184–187.
- Pedrosa C, Costa H, Oliveira G, Romariz J, Praca F: Anaphylaxis to povidone in a child. Pediatr Allergy Immunol 2005;16:361–362.
- Nishi H, Nishimura S, Higashiura M, Ikeya N, Ohta H, Tsuji T, Nishimura M, Ohnishi S, Higashi H: A new method for histamine release from purified peripheral blood basophils using monoclonal antibody-coated magnetic beads. J Immunol Methods 2000;240:39–46.
- Cameron AM: Blood plasma expander-PVP. Del Med J 1954;26:149–151.
- Zimecki M, Webb DR: The influence of molecular weight on immunogenicity and suppressor cells in the immune response to polyvinylpyrrolidone. Clin Immunol Immunopathol 1978;9:75–79.
- Saez MPL, Barrio M, Zubeldia J M, Prieto A, Olalde S, Baeza M L: Acute IgE-mediated generalized urticaria-angioedema after topical application of povidone-iodine. Allergol Immunopathol 1998;26:23–26.
- Adachi A, Fukunaga A, Hayashi K, Kunisada M, Horikawa T: Anaphylaxis to polyvinylpyrrolidone in an analgesic preparation. Contact Derm 2003;48:133–136.
- Le Pabic F, Sainte-Laudy J, Blanchard N, Moneret-Vautrin DA: First case of anaphylaxis to iodinated povidone. Allergy 2003;58:826–827.
- Gonzalo Garijo MA, Duran Quintana JA, Bobadilla Gonzalez P, Maiquez Asuero P: Anaphylactic shock following povidone. Ann Pharmacother 1996;30:37–40.
- Ronnau AC, Wulferink M, Gleichmann E, Unver E, Ruzicka T, Krutmann J, Grewe M: Anaphylaxis to polyvinylpyrrolidone in an analgesic preparation. Br J Dermatol 2000;143:1055–1058.
- Budde IK, Aalberse RC. Histamine-releasing factors, a heterogeneous group of different activities. Clin Exp Allergy 2003;33:1175–1182.
- Budde IK, de Heer PG, Natter S, Mahler V, van der Zee JS, Valenta R, Aalberse RC: Studies on the association between immunoglobulin E autoreactivity and immunoglobulin E-dependent histamine-releasing factors. Immunology 2002;107:243–251.
- Bergfeld WF, Belsito DV, Carlton WW, Klaassen CD, Schroeter AL, Shank RC, Slaga TJ: Final report on the safety assessment of polyvinylpyrrolidone (PVP). Int J Toxicol 1998;17:95–130.
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