Delayed hypersensitivity reaction after intravenous glucagon administered for a barium enema: a case report.
BACKGROUND
Few reports have documented allergic hypersensitivity reactions after barium gastrointestinal studies. Of these, the barium suspension, its additives or intravenous glucagon given for bowel relaxation has been implicated as possible allergens. We report a patient with delayed hypersensitivity reaction after barium enema and discuss the reasons supporting glucagon as the possible allergen.


METHODS
A 74-year-old Chinese woman presented with pruritic rashes, 1 day after a barium enema. Intravenous glucagon (GlucaGen, Novo Nordisk, Denmark) was administered during the barium enema. Physical examination revealed palpable purpuric rashes on the legs with erythematous papules and plaques on the arms and trunk. Skin biopsy demonstrated superficial perivascular infiltrates of lymphocytes and eosinophils, consistent with a drug eruption.


RESULTS
The rashes resolved with antihistamines and topical corticosteroids.


CONCLUSIONS
This report highlights the potential of glucagon to cause hypersensitivity reactions. Awareness of this entity is important for the prevention and recognition of complications during barium gastrointestinal studies.
Neoh
Ching Yin
CY
National Skin Centre, Singapore. cyneoh@nsc.gov.sg
Tan
Audrey W H
AW
Leow
Yung Hian
YH
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D017609:Barium Compounds; D004342:Drug Hypersensitivity / Q000209:etiology*; D004733:Enema; D005260:Female; D005934:Glucagon / Q000008:administration & dosage / Q000009:adverse effects*; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000209:etiology*; D007275:Injections, Intravenous; D010276:Parasympatholytics / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D017609:Barium Compounds; D006634:Histamine H1 Antagonists; D010276:Parasympatholytics; D005934:Glucagon