Amoxicillin Morbilliform Drug Eruption in Pediatric Male with Poor Feeding Treated with Cyproheptadine: A Case Report
Background: Cyproheptadine (CY) is an antihistaminic agent that is commonly used for symptom relief in skin conditions. The most common pattern of cutaneous drug eruption in children is the exanthematous type, with the penicillin family often cited. CY is also an antiserotoninergic agent with the side effect of appetite stimulation and has been used in children with poor feeding and poor weight gain.
The Case: We report a case of a 31-month-old male patient seen in the outpatient setting with a diffuse morbilliform rash after use of amoxicillin for right otitis media. The patient was a post-operative congenital heart disease (CHD) patient, actively being treated with CY for feeding difficulties and low weight often seen in the CHD population. Amoxicillin was discontinued, while CY was continued. The patient did not encounter any pruritic symptoms during morbilliform rash, while weight gain of 3.1 kg occurred over a 9 months period, increasing patient from the 10th to 41st percentile.
Conclusion: A review of studies on CY has shown antiallergic properties in histamine-mediated hypersensitivity reactions, most likely through H1 receptor antagonism. This mechanism may be used to address the pruritic symptoms during type IV T-cell mediated hypersensitivity cutaneous drug eruptions. CY also possesses 5-HT receptor antagonist properties with demonstrated ability to increase appetite in poor feeding pediatric patients. CY was successfully used for this purpose in our CHD patient.
Shin HT, Chang MW. Drug eruptions in children. Curr Probl Pediatr. 2001 Aug;31(7):207-34.
Sant'Anna AM, Hammes PS, Porporino M, Martel C, Zygmuntowicz C, Ramsay M. Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program. J Pediatr Gastroenterol Nutr. 2014 Nov;59(5):674-8.
De Bruyne P, Christiaens T, Boussery K, Mehuys E, Van Winckel M. Are antihistamines effective in children? A review of the evidence. Arch Dis Child. 2017 Jan;102(1):56-60.
Cyproheptadine hydrochloride [package insert]. Sellersville, PA: Teva Pharmaceuticals USA. 2009.
Couluris M, Mayer JL, Freyer DR, Sandler E, Xu P, Krischer JP. The effect of cyproheptadine hydrochloride (periactin) and megestrol acetate (megace) on weight in children with cancer/treatment-related cachexia. J Pediatr Hematol Oncol. 2008 Nov;30(11):791-7.
Torres MJ, Blanca M. The complex clinical picture of beta-lactam hypersensitivity: penicillins, cephalosporins, monobactams, carbapenems, and clavams. Med Clin North Am. 2010 Jul;94(4):805-20, xii.
Fadel R, David B, Rassemont R, Herpin-Richard N, Borgnon A, Rihoux JP. Eosinophil infiltration: effects of H1 antihistamines. J Am Acad Dermatol. 1991 Jun;24(6 Pt 2):1094-6.
Vallero S, Mondino A, Farinasso L, Ansaldi G, Davitto M, Ramenghi U. Successful Use of Antihistamines in Severe Hypereosinophilia. Pediatr Rep. 2012 Jun 22;4(3):e26.
Riedl MA, Casillas AM. Adverse drug reactions: types and treatment options. Am Fam Physician. 2003 Nov 1;68(9):1781-90.
Carder KR. Hypersensitivity reactions in neonates and infants. Dermatol Ther. 2005 Mar-Apr;18(2):160-75.
Denman ST. A review of pruritus. J Am Acad Dermatol. 1986 Mar;14(3):375-92.
Romano A, Quaratino D, Papa G, Di Fonso M, Venuti A. Aminopenicillin allergy. Arch Dis Child. 1997 Jun;76(6):513-7.
Roman B. Nourishing little hearts: nutritional implications for congenital heart defects. Pract Gastroenterol. 2011,8:11-32.
McGovern T, McNamee J, Marcus S, Kashani J. When Too Much Is Enough: Pediatric Cyproheptadine Overdose with Confirmatory Level. Clin Pract Cases Emerg Med. 2017 Jul 6;1(3):205-207.
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