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A clozapine-induced hypersensitivity reaction

Published online by Cambridge University Press:  17 October 2017

L. Curtis
Affiliation:
Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
B. Hallahan
Affiliation:
Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland Department of Psychiatry, Clinical Science Institute, National University of Ireland, Galway, Ireland
F. Byrne*
Affiliation:
Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland Department of Psychiatry, Clinical Science Institute, National University of Ireland, Galway, Ireland
*
*Address for correspondence: F. Byrne, Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland. (Email: [email protected])

Abstract

A 57-year-old female patient with a diagnosis of schizo-affective disorder since 1986 was commenced on clozapine due to persistent positive and negative psychotic symptoms in September 2014. After commencement of clozapine she was delusion free and demonstrated an improvement in negative symptoms. Three months after commencement of clozapine she developed a hypersensitivity reaction. Her symptoms continued to deteriorate despite being prescribed an anti-histamine. Clozapine was discontinued 6 days after the appearance of a generalised pruritic rash, as it was believed to be the probable cause. There was complete resolution of symptoms 1 week after discontinuation of clozapine. Clozapine was replaced with olanzapine and amisulpride. There has been no similar cutaneous or allergic reactions for the past 30 months.

Type
Case Report
Copyright
© College of Psychiatrists of Ireland 2017

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References

Bingham, C, Saini, S, Feldweg, AM (2010). An overview of angioedema: pathogenesis and causes. UpToDate, Waltham, MA.Google Scholar
Bingham, C, Zuraw, B (2010). An overview of angioedema: clinical features, diagnosis, and management. Up to Date Waltham, MA.Google Scholar
Burton, S (2006). Symptom domains of schizophrenia: the role of atypical antipsychotic agents. Journal of Psychopharmacology 20 (Suppl. 6): 619.CrossRefGoogle ScholarPubMed
Coombs, P, Gell, P (1968). Classification of the allergic reactions responsible for clinical hypersensitivity and disease. In Clinical Aspects of Immunology (ed. R. R. Gell), pp. 575596. Oxford University Press: Oxford.Google Scholar
Cooney, C, Nagy, A (1995). Angio-oedema associated with risperidone. BMJ 311, 1204.CrossRefGoogle ScholarPubMed
Freiman, A, Borsuk, D, Sasseville, D (2005). Dermatologic emergencies. Canadian Medical Association Journal 173, 13171319.CrossRefGoogle ScholarPubMed
Kaplan, AP, Greaves, MW (2005). Angioedema. Journal of the American Academy of Dermatology 53, 373388.CrossRefGoogle ScholarPubMed
Lewis, SW, Barnes, TR, Davies, L, Murray, RM, Dunn, G, Hayhurst, KP, Markwick, A, Lloyd, H, Jones, PB (2006). Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Schizophrenia Bulletin 32, 715723.CrossRefGoogle ScholarPubMed
McEvoy, J, Lieberman, J, Stroup, T, Davis, S, Meltzer, H, Rosenheck, R, Swartz, M, Perkins, D, Keefe, R, Davis, C, Severe, J, Hsiao, J (2006). Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. The American Journal of Psychiatry 163, 600610.CrossRefGoogle Scholar
Mishra, B, Sahoo, S, Sarkar, S, Akhtar, S (2007). Clozapine-induced angioneurotic edema. General Hospital Psychiatry 29, 7880.CrossRefGoogle ScholarPubMed
Mohan, T, Dhillon, R (2009). Ziprasidone-induced angioedema: a case report. The Journal of Clinical Psychiatry 70, 1054.CrossRefGoogle ScholarPubMed
Murphy, R, Gallagher, A, Sharma, K, Ali, T, Lewis, E, Murray, I, Hallahan, B (2015). Clozapine-induced stuttering: an estimate of prevalence in the west of Ireland. Therapeutic Advances in Psychopharmacology 5, 232236.CrossRefGoogle Scholar
Naranjo, CA, Busto, U, Sellers, EM, Sandor, P, Ruiz, I, Roberts, EA, Janecek, E, Domecq, C, Greenblatt, DJ (1981). A method for estimating the probability of adverse drug reactions. Clinical Pharmacology and Therapeutics 30, 239245.CrossRefGoogle ScholarPubMed
Posadas, S, Pichler, W (2007). Delayed drug hypersensitivity reactions – new concepts. Clinical and Experimental Allergy 37, 989999.CrossRefGoogle ScholarPubMed
Romagnani, S (1997). The Th1/Th2 paradigm. Immunology Today 18, 263266.CrossRefGoogle ScholarPubMed
Soumya, RN, Grover, S, Dutt, A, Gaur, N (2010). Angioneurotic edema with risperidone: a case report and review of literature. General Hospital Psychiatry 32, 646.e1-3.CrossRefGoogle ScholarPubMed
Tatar, ZB, Oflaz, S, Baran, B (2014). A case of late-onset angioedema associated with clozapine and redevelopment of angioedema with olanzapine. Journal of Clinical Psychopharmacology 34, 523525.CrossRefGoogle ScholarPubMed
Vleeming, W, van Amsterdam, JG, Stricker, BHC, de Wildt, DJ (1998). ACE inhibitor-induced angioedema. Drug Safety 18, 171188.CrossRefGoogle ScholarPubMed
Wheeler, A, Humberstone, V, Robinson, G (2009). Outcomes for schizophrenia patients with clozapine treatment: how good does it get? Journal of Psychopharmacology 23, 957965.CrossRefGoogle ScholarPubMed