Buprenorphine
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Hypersensitivity: case report A 21-year-old woman developed hypersensitivity during buprenorphine treatment for opioid addiction. The woman had a 6-year history of opioid addiction and had experienced hypersensitivity reactions to various opioid medications. She started a rehabilitation regimen of sublingual buprenorphine 2mg twice daily plus cetirizine daily to minimise adverse reactions. After 6 uneventful months, she missed a cetirizine dose and for the next 2 months, buprenorphine dosing led to dizziness, hives, skin tingling, flushing, facial oedema, nausea and worsening respiratory symptoms (sensation of throat closing, coughing and difficulty breathing). The symptoms lasted about 10 minutes, occurred several times a week and improved after cetirizine administration. Her symptoms completely abated after buprenorphine was discontinued. However, she relapsed into heroin use, causing severe hypersensitivity reactions, despite daily cetirizine. Further evaluation revealed mild dermatographia. In order to continue rehabilitation, the woman was admitted to the ICU for buprenorphine desensitisation. After premedication with cetirizine, she received eight incremental doses (titrated up to 1.2mg) of sublingual buprenorphine tablets, crushed and suspended in sterile water, administered every 30 minutes. No reactions occurred during desensitisation. After 3.5 months of uneventful maintenance treatment on buprenorphine 2mg twice daily and cetirizine, the woman relapsed into heroin use, this time without allergic symptoms. Buprenorphine was increased to 3mg twice daily. Maintenance treatment remained uneventful until the time of reporting (over 7 months). Author comment: "The successful desensitisation to buprenorphine in our patient suggests that desensitisation to mast cell–mediated disease does not necessarily require FceR1 cross-linking and might occur via downregulation of the opiate receptor. Downregulation of the opiate receptor might allow patients desensitised to one opiate to tolerate other opiates, and may explain why our patient, after desensitisation to buprenorphine, became tolerant to heroin". Stutius LM, et al. Sublingual desensitization for buprenorphine hypersensitivity. Journal of Allergy and Clinical Immunology 125: 938-939, No. 4, Apr 2010. Available from: URL: http://dx.doi.org/10.1016/j.jaci.2009.12.982 803014109 USA
0114-9954/10/1301-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 15 May 2010 No. 1301
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