title: Urticaria associated with parenteral nutrition.
abstract: We report a 53-year-old female patient with short bowel syndrome who developed urticaria after administration of cyclic parenteral nutrition (PN). The urticaria occurred 2 hours into the 12-hour nocturnal infusion and resolved completely 1 hour after discontinuation of the PN infusion. The urticaria occurred despite removing lipids from the 3-in-1 PN solution. The urticaria did not occur when the multivitamin preparation was removed from the PN. Upon rechallenge with a PN solution containing a multivitamin, the urticaria reoccurred. Prick skin testing using the multivitamin in increasing aliquots was negative. Serum tryptase and 12-hour urinary histamine level during PN infusion containing the multivitamin was unchanged compared with baseline measurements. The patient had no allergic reaction using a similar dose of an oral multivitamin. This case illustrates that allergic reactions from PN infusion may occur and that the multivitamin preparation can be the cause.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA. scolapio.james@mayo.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Scolapio
authors.forename: Marcus
authors.initials: M
authors.lastname: Ferrone
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gillham
mesh_terms: D005260:Female; D005512:Food Hypersensitivity / Q000209:etiology; D005526:Food, Formulated; D006801:Humans; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012778:Short Bowel Syndrome / Q000628:therapy*; D014581:Urticaria / Q000209:etiology*; D014815:Vitamins / Q000276:immunology*
chemical_list: D014815:Vitamins