buprenorphine and Dermatitis--Allergic-Contact

Fentanyl is primarily an opioid agonist. It is frequently used in general anesthesia as a potent analgesic. It can be administered either orally, transdermally or systemically. Adverse effects due to opium alkaloids are usually because of a non-specific histamine release. Only in a few cases, a true allergy mechanism could be involved. Immediate reactions to opioids are most frequent than delayed reactions. In the past years, delayed reactions have increased in frequency because of the wide use of Transdermal Therapeutic System (TTS) with several opioids for its potent analgesic properties.. The objective was to study delayed reaction to fentanyl TTS and cross-reactivity with other opioids.. A 52-year-old man with a diagnosis of pancreatic cancer who began treatment for a bone metastases pain with fentanyl TTS, at a dose of 50 micrograms per hour (mcg/h) is the subject of the study. After 10-15 days of treatment, he developed an itchy papulovesicular rash in the application site of the fentanyl TTS. Afterward, eczema and superficial desquamation just on the application site of the patch were observed. He changed several times the site of application, but always developing the same symptoms in every single application. Later on, he tolerated other opioids such as oral morphine or tramadol. An allergy workout was performed. We performed Patch Tests (PT) with fentanyl at a concentration of 10% in aqua (aq) and with buprenorphine 10% aq., in order to investigate probable crossreactivity among other topical opioids.. Readings were recorded at day 2 (D2) and day 4 (D4), with positive PT only with fentanyl at D2 (+++) and D4 (+++). We decided to perform a single-blind challenge test with buprenorphine 35 mcg/h in TTS, with a negative result. At this moment, fentanyl TTS was replaced by buprenorphine TTS, with good tolerance.. We present the case of Allergic Contact Dermatitis (ACD) due to hypersensitivity to fentanyl with good tolerance to buprenorphine. Positive PT in this patient suggests a type IV hypersensitivity mechanism. Allergic reactions to opioids are frequently immediate, but delayed reactions could appear, especially when the drug is administered topically.

Topics: Administration, Cutaneous; Buprenorphine; Dermatitis, Allergic Contact; Drug Hypersensitivity; Drug Substitution; Drug Tolerance; Exanthema; Fentanyl; Humans; Hypersensitivity, Delayed; Male; Middle Aged; Pain Management; Pancreatic Neoplasms; Skin Tests

Transdermal buprenorphine (TDB) is a widely used analgesic for moderate pain. TDB is generally well tolerated, but both irritant and allergic contact dermatitis occur at patch application sites. Oral opioid tolerance in patients with allergic contact dermatitis to TDB remains controversial. Here, we describe 3 patients with allergic contact dermatitis to TDB who subsequently used oral opioid derivatives without adverse reactions. Thus, oral intolerance to opioid derivatives is not a rule in patients with allergic contact dermatitis to TDB, but the possibility should be taken into consideration.

Topics: Adult; Analgesics, Opioid; Buprenorphine; Dermatitis, Allergic Contact; Female; Humans; Injections, Intradermal; Male; Middle Aged; Pain; Withholding Treatment

To characterize the profile of application site reactions (ASRs) for patients treated with the buprenorphine transdermal system (BTDS) in chronic pain studies.. The incidences of ASRs during treatment with BTDS were examined using (a) integrated data from 16 controlled and uncontrolled Phase III chronic pain studies (N = 6566), (b) a subset of integrated data that focused on the double-blind phases of five enriched, placebo-controlled studies (n = 1806) and (c) data from an international postmarketing drug safety database. These data were compared with the ASR data reported in the full prescribing information of other transdermal patches marketed in the US.. Among the 6566 patients, the overall incidence of ASRs was 23.4%, of which 98.3% were mild to moderate in intensity, none were serious and 4.4% led to treatment discontinuation. Rates of severe and inflammatory ASRs were low. Among the 1806 patients, ASR rates were higher with BTDS (16.6%) than placebo transdermal system (12.7%). Among the 6566 patients, the 1806 patients, and the postmarketing data, the most common ASRs seen were pruritus, erythema and rash. Incidences of most ASRs for other selected transdermal products were 17% or lower.. Incidence rates of ASRs in patients treated with BTDS were low and infrequently led to discontinuation. Severe and inflammatory-type ASRs were not common. The ASR profile of BTDS was comparable with those of other transdermal patches.

Topics: Administration, Cutaneous; Aged; Buprenorphine; Chronic Pain; Clinical Trials, Phase III as Topic; Dermatitis, Allergic Contact; Double-Blind Method; Female; Humans; Male; Middle Aged; Transdermal Patch

Topics: Administration, Cutaneous; Adult; Analgesics, Opioid; Buprenorphine; Dermatitis, Allergic Contact; Erythema Nodosum; Female; Humans; Male; Middle Aged; Pain; Patch Tests

Topics: Administration, Oral; Analgesics, Opioid; Buprenorphine; Dermatitis, Allergic Contact; Dermatitis, Contact; Female; Humans; Middle Aged; Patch Tests; Tramadol

Topics: Administration, Cutaneous; Analgesics, Opioid; Buprenorphine; Dermatitis, Allergic Contact; Dermatitis, Contact; Female; Humans; Middle Aged; Tramadol

Buprenorphine is a low-molecular-weight, lipophilic, opioid analgesic. The transdermal delivery system (TDS) containing it has skin irritation potential, but at least two cases of contact allergy to the active principal have been described previously.. To confirm allergic contact dermatitis from transdermal buprenorphine (TDB) in five older patients suffering from chronic pain and who developed persistent, pruritic erythematous plaques at the contact sites, with two of them also presenting with a generalized skin eruption.. Besides the baseline patch test series, all five patients were tested with the TDB, four of whom were also tested with the placebo transdermal delivery system as provided by the manufacturer; one patient was also tested with other preparations containing buprenorphine.. All reacted to the TDB containing the active principal, the placebo being negative in the four patients tested. The patient tested with the other buprenorphine preparations did react positively to them as well. Tests with TDB in 28 healthy controls were negative.. We report five cases of delayed hypersensitivity reactions to a TDS containing buprenorphine. Such adverse reactions might be under-reported. A fentanyl-containing TDS is a good alternative in these cases.

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Analgesics, Opioid; Buprenorphine; Dermatitis, Allergic Contact; Erythema Nodosum; Female; Humans; Male; Middle Aged; Pain; Patch Tests

Topics: Administration, Cutaneous; Aged, 80 and over; Analgesics, Opioid; Buprenorphine; Dermatitis, Allergic Contact; Drug Hypersensitivity; Female; Humans; Pain; Patch Tests; Skin

Topics: Administration, Cutaneous; Aged; Analgesics, Opioid; Buprenorphine; Dermatitis, Allergic Contact; Female; Humans; Patch Tests