acyclovir and Angioedema

The incidence of acyclovir-induced hypersensitivity is rare. To our knowledge, there are four published case reports of oral acyclovir desensitization in adults. Evidence-based guidelines prompt the use of acyclovir for herpes simplex virus (HSV) prophylaxis and treatment. Literature on the cross-reactivity of structurally similar antiviral agents is conflicting, presenting a clinical challenge when choosing an alternative agent. This is a case of successful acyclovir desensitization in an allogeneic stem cell transplant patient.. A 69-year-old female patient, diagnosed with myelodysplastic/myeloproliferative neoplasm, presented to the hospital for donor mismatch allogeneic bone marrow transplant. The patient reported acyclovir-induced angioedema while receiving treatment for non-complicated herpes zoster (shingles) infection.

Topics: Acyclovir; Aged; Angioedema; Antiviral Agents; Bone Marrow Transplantation; Desensitization, Immunologic; Drug Hypersensitivity; Female; Herpes Simplex; Humans

Topics: Acyclovir; Adult; Angioedema; Cosmetic Techniques; Disease Progression; Female; Follow-Up Studies; Herpes Simplex; Humans; Hyaluronic Acid; Injections, Subcutaneous; Lip; Methylprednisolone; Severity of Illness Index

A probable acyclovir-associated hypersensitivity reaction resulting in severe facial angioedema and respiratory distress is reported.. A 51-year-old woman with human immunodeficiency virus (HIV) infection and end-stage renal disease arrived at the emergency department (ED) with a diffuse rash on the chest and back; she was diagnosed with varicella-zoster virus infection, received one dose of i.v. acyclovir, and was discharged home with a prescription for valacyclovir. After taking one dose of the drug, she became confused and agitated. The next day the patient returned to the ED; she was confused and unresponsive, with signs and symptoms suggesting viral encephalitis. After a workup including lumbar puncture fluid, she was treated empirically with i.v. acyclovir for viral encephalitis. Within one hour of receiving the acyclovir infusion, the patient developed angioedema of the lips, tongue, and periorbital areas requiring intubation and transfer to the intensive care unit. Further acyclovir therapy was withheld, and foscarnet therapy was initiated for the presumptive treatment of viral encephalitis. Over the next few days, the patient's angioedema completely resolved; her mental status gradually improved while she completed a 14-day course of foscarnet therapy. The application of the Naranjo scale indicated a probable adverse reaction to acyclovir, likely mediated by acyclovir-specific immunoglobulin E, highlighting the need to consider alternative antiviral agents without cross-reactivity to acyclovir in patients with confirmed or suspected viral encephalitis.. A 51-year-old woman with HIV infection developed probable acyclovir-induced angioedema after receiving i.v. acyclovir therapy for suspected viral encephalitis.

Topics: Acyclovir; Angioedema; Antiviral Agents; Encephalitis, Varicella Zoster; Face; Female; HIV Infections; Humans; Immunoglobulin E; Infusions, Intravenous; Kidney Failure, Chronic; Middle Aged; Respiration Disorders; Severity of Illness Index

A 29-year-old patient with HIV developed a facial angioedema hypersensitivity reaction to aciclovir when treated for acute retinal necrosis secondary to a herpes virus infection. She developed a similar reaction to famciclovir. Successful rapid desensitisation with oral aciclovir was performed and she became tolerant to aciclovir. She successfully completed 28 months of continuous treatment with no further reactions. However, 28 months later she experienced blurred vision and resumed taking oral aciclovir without a preceding desensitisation regimen. No allergic reaction occurred.

Topics: Acyclovir; Adult; Angioedema; Antiviral Agents; Desensitization, Immunologic; Drug Eruptions; Facial Dermatoses; Female; Humans

Angioedema and chronic urticaria result from a variety of causes. Our purpose was to study the therapeutic effect of oral acyclovir on selected patients, by observing the effect of acyclovir in a dosage of from 100 mg every six hours to 800 mg every four hours in fourteen patients with angioedema or chronic urticaria. Five of twelve patients with chronic urticaria and one patient each with hereditary angioedema and idiopathic angioedema noted complete remission with acyclovir therapy. Discontinuation of the acyclovir resulted in reappearance of the hives. Since these patients had high antibody titers to either herpes simplex virus or Epstein-Barr virus, we conclude that acyclovir produced its therapeutic effect by suppressing a circulating viral antigen.

Topics: Acyclovir; Adult; Aged; Angioedema; Antiviral Agents; Chronic Disease; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Prognosis; Urticaria