title: Skin reaction to inhaled tiotropium bromide: a case report.
abstract: BACKGROUND
  Systemic reactions to inhaled drugs are rare. To the best of our knowledge, we report the first case of generalized itching related to the use of tiotropium bromide, a long acting inhaled anti-cholinergic agent commonly used to treat chronic obstructive pulmonary disease.
  
  
  METHODS
  A 78-year-old Caucasian woman was referred to our facility for allergological evaluation. Our patient had been treated twice with tiotropium for chronic obstructive pulmonary disease and had experienced an allergic reaction with itching. We performed a double-blind placebo-controlled inhalation challenge for our patient with tiotropium and a placebo. Inhalation tests yielded positive results for tiotropium and negative results for the placebo. The results of a skin prick test with tiotropium were negative.
  
  
  CONCLUSIONS
  These findings reveal that tiotropium may elicit immediate skin allergic reactions. The negative result from the skin test suggests that such a reaction is not immunoglobulin E-mediated.
authors: Department of Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy. cristoforo.incorvaia@gmail.com.
authors: Cristoforo
authors: C
authors: Incorvaia
authors: Nicola
authors: N
authors: Fuiano
authors: Raffaella
authors: R
authors: Megali
authors: Gian Galeazzo
authors: GG
authors: Riario-Sforza