title: Concomitant sensitization to inhaled budesonide and oral nystatin presenting as allergic contact stomatitis and systemic allergic contact dermatitis.
abstract: Concomitant allergic reactions to multiple drugs are uncommon. We report the case of a 66-year-old woman who presented with concomitant sensitization to inhaled budesonide and oral nystatin presenting as allergic contact stomatitis and systemic allergic contact dermatitis. It is notable that one of the reactions was caused by oral nystatin, which generally is not considered to be allergenic due to its poor intestinal absorption. Diagnoses were confirmed on patch testing with histologic examination along with oral challenge testing. We also used challenge testing to rule out cross-reactivity among nystatin and other macrolide drugs, both antifungals and antibiotics.
authors.affiliation: Department of Allergy, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Vega
authors.affiliation: From the Department of Allergy, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Tania
authors.initials: T
authors.lastname: Ramos
authors.affiliation: From the Department of Allergy, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Las Heras
authors.affiliation: From the Department of Allergy, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects*; D002180:Candidiasis, Oral / Q000188:drug therapy / Q000209:etiology; D003371:Cough / Q000188:drug therapy; D017449:Dermatitis, Allergic Contact / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D009761:Nystatin / Q000008:administration & dosage / Q000009:adverse effects*; D013280:Stomatitis / Q000139:chemically induced*
chemical_list: D000935:Antifungal Agents; D005938:Glucocorticoids; D009761:Nystatin; D019819:Budesonide