Journal List > Allergy Asthma Respir Dis > v.5(4) > 1059264

Kang, Lee, Sohn, Kang, Cho, and Kang: A case series of eperisone-induced immediate hypersensitivity

Abstract

Eperisone is a widely used muscle relaxant and believed to be relatively free of adverse drug reactions. However, a rare case of fatal anaphylaxis has been reported in the literature. Poor awareness due to its rarity and combined administration with other drugs are the major hurdles in diagnosing eperisone-induced anaphylaxis. We experienced 3 cases of immediate hypersensitivity reaction oc-curring after eperisone administration. Case 1, a 63-year-old female, was admitted via the Emergency Department with urticaria, generalized erythroderma, sore throat, chest discomfort, and dyspnea within 1 hour after administration of common cold remedy. Case 2, a 58-year-old male, visited our allergy clinic to detect culprit drugs. He experienced itching, urticaria, hypotension for several hours after administration of the pills for back pain in the last 3 years. Case 3, a 58-year-old male developed urticaria and dyspnea after administration of medication for a headache. He also experienced urticaria and facial edema after administration of the common cold remedy. Among the medications, eperisone hydrochloride was proven as the culprit drug and others were excluded through oral provocation tests. We advised them to avoid eperisone and issued drug safety card. Clinicians should be aware that eperisone hydrochloride is a potential culprit agent of fatal anaphylaxis.

REFERENCES

1. Iwase S, Mano T, Saito M, Ishida G. Effect of a centrally-acting muscle relaxant, eperisone hydrochloride, on muscle sympathetic nerve activity in humans. Funct Neurol. 1992; 7:459–70.
2. Ochiai T, Ishida R. Pharmacological studies on 6-amino-2-fluoromethyl-3-(O-tolyl)-4(3H)-quinazolinone (afloqualone), a new centrally acting muscle relaxant. (II) Effects on the spinal reflex potential and the rigidity. Jpn J Pharmacol. 1982; 32:427–38.
3. Cabitza P, Randelli P. Efficacy and safety of eperisone in patients with low back pain: a double blind randomized study. Eur Rev Med Pharmacol Sci. 2008; 12:229–35.
4. Bavage S, Durg S, Ali Kareem S, Dhadde SB. Clinical efficacy and safety of eperisone for low back pain: a systematic literature review. Pharmacol Rep. 2016; 68:903–12.
crossref
5. Choonhakarn C. Non-pigmenting fixed drug eruption: a new case due to eperisone hydrochloride. Br J Dermatol. 2001; 144:1288–9.
crossref
6. Ueno T, Kawana S. A case of eperisone hydrochloride (myonal)–induced drug eruption leading to erythema and angioedema. Arerugi. 2007; 56:709–13.
7. Yamamoto Y, Kadota M, Nishimura Y. A case of eperisone hydrochlorideinduced acute generalized exanthematous pustulosis. J Dermatol. 2004; 31:769–70.
crossref
8. Hur GY, Hwang EK, Moon JY, Ye YM, Shim JJ, Park HS, et al. Oral muscle relaxant may induce immediate allergic reactions. Yonsei Med J. 2012; 53:863–5.
crossref
9. Kim SH, Lee J, Kim SH, Kim HW, Kim YU, Lim Y, et al. Anaphylaxis caused by muscle relaxant (eperisone hydrochloride). Allergy Asthma Respir Dis. 2013; 1:172–5.
crossref
10. Miki Y, Washio K, Masaki T, Nakata K, Fukunaga A, Nishigori C. A case of eperisone hydrochloride-induced anaphylaxis: a true type I reaction? Allergol Int. 2017; 66:152–3.
crossref
11. Naoichi T, Yasuhiro H, Ryuichi N, Keizo F, Hiroshi S, Masahiro O. Clinical evaluation of E-0646 (eperisone hydrochloride) on cervicobrachial syndrome, periarthritis scapulohumeralis and lumbago: a double-blind controlled study. Clin Eval. 1984; 12:231–73.
12. Bresolin N, Zucca C, Pecori A. Efficacy and tolerability of eperisone and baclofen in spastic palsy: a double-blind randomized trial. Adv Ther. 2009; 26:563–73.
crossref
13. Yoo MC, Cho YJ, Lee HK. The clinical evaluation of eperisone hydrochloride (Mulex). J Korean Rheum Assoc. 1994; 1:239–43.
14. Ribi C, Vermeulen C, Hauser C. Anaphylactic reactions to tolperisone (Mydocalm). Swiss Med Wkly. 2003; 133:369–71.
15. Kim SY, Kim JH, Jang YS, Choi JH, Park S, Hwang YI, et al. The basophil activation test is safe and useful for confirming drug-induced anaphylaxis. Allergy Asthma Immunol Res. 2016; 8:541–4.
crossref
16. Fujioka M, Kuriyama H. Eperisone, an antispastic agent, possesses vaso-dilating actions on the guinea-pig basilar artery. J Pharmacol Exp Ther. 1985; 235:757–63.
17. McNeil BD, Pundir P, Meeker S, Han L, Undem BJ, Kulka M, et al. Identification of a mast-cell-specific receptor crucial for pseudo-allergic drug reactions. Nature. 2015; 519:237–41.
crossref
18. Live symposium of Epesin SR. Medical Times [Internet]. 2015 June 3 [cited 2017 May 14]. Availabler from. http://www.medicaltimes.com/Us-ers4/Academy/AcademyNewsView.html?ID=1097459.
TOOLS
Similar articles