title: Anaphylaxis to polyvinylpyrrolidone in povidone-iodine for impetigo contagiosum in a boy with atopic dermatitis.
abstract: 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.
  
  
  METHODS
  A 9-year-old boy with eosinophilia (1,500/microl) 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.
authors.affiliation: Department of Pediatrics, Nara Medical University School of Medicine, Kashihara, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Sakurai
authors.forename: Shingo
authors.initials: S
authors.lastname: Kawahara
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Takeda
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Murakami
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshioka
mesh_terms: D000707:Anaphylaxis / Q000276:immunology*; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D002648:Child; D003876:Dermatitis, Atopic / Q000276:immunology*; D006801:Humans; D007169:Impetigo / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D010592:Pharmaceutic Aids / Q000009:adverse effects*; D011205:Povidone / Q000009:adverse effects*; D011206:Povidone-Iodine / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D000891:Anti-Infective Agents, Local; D010592:Pharmaceutic Aids; D011206:Povidone-Iodine; D011205:Povidone