Long QT syndrome in a patient with allergic rhinoconjunctivitis and auto-immune diabetes: focus on the choice of anti-H1 drugs.
The long QT syndrome is a rare disease. The prevalence is estimated at 1/5 000 to 1/20,000. Numerous drugs are contra-indicated because they can lengthen the QT interval. A case of pollen allergy in an adolescent with LQTS is described. The possibility to prescribe anti-H1 drugs is reviewed since cases of torsades de pointe and even deaths have been reported for terfenadine and astemizole. Diphenhydramine, orphenadrine and hydroxyzine are contra-indicated. No accidents and no effects on the QT interval have been published for ebastine, fexofenadine, desloratadine and levocetirizine. These anti-H1 drugs could be used with great care, without any association with drugs resulting in low serum potassium level. Azelastine eye drops have been authorized and a routine protection by inhaled corticosteroids during the pollinic period has been advised in this adolescent treated by betablockers.
Moneret-Vautrin
D A
DA
Department of Internal Medicine - Clinical Immunology and Allergology, University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy Cedex, France.
de Chillou
C
C
Codreanu
A
A
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D002090:Butyrophenones / Q000627:therapeutic use; D017332:Cetirizine / Q000627:therapeutic use; D003233:Conjunctivitis, Allergic / Q000150:complications* / Q000188:drug therapy*; D004205:Cromolyn Sodium / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D006321:Heart / Q000187:drug effects; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D010879:Piperazines / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications* / Q000188:drug therapy*; D016593:Terfenadine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D018927:Anti-Asthmatic Agents; D002090:Butyrophenones; D006634:Histamine H1 Antagonists; D010879:Piperazines; D010880:Piperidines; C472067:levocetirizine; D016593:Terfenadine; C093230:fexofenadine; D004205:Cromolyn Sodium; C058249:ebastine; D017332:Cetirizine