Anaphylaxis to polyvinylpyrrolidone in povidone-iodine for impetigo contagiosum in a boy with atopic dermatitis.
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.
Yoshida
Koichi
K
Department of Pediatrics, Nara Medical University School of Medicine, Kashihara, Japan.
Sakurai
Yoshihiko
Y
Kawahara
Shingo
S
Takeda
Tomohiro
T
Ishikawa
Tomoaki
T
Murakami
Tomohiko
T
Yoshioka
Akira
A
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*
D000891:Anti-Infective Agents, Local; D010592:Pharmaceutic Aids; D011206:Povidone-Iodine; D011205:Povidone