{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T15:18:24Z","timestamp":1748359104969,"version":"3.37.3"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T00:00:00Z","timestamp":1612483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T00:00:00Z","timestamp":1612483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002456","name":"Chonnam National University","doi-asserted-by":"publisher","award":["2018-3540"],"award-info":[{"award-number":["2018-3540"]}],"id":[{"id":"10.13039\/501100002456","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Allergy Asthma Clin Immunol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Erdosteine is used as a mucolytic agent and has a low incidence of adverse drug reactions, most of which are gastrointestinal and mild. Moreover, drug antigens rarely induce multiple simultaneous immunologic reactions. Only one previous case report has demonstrated hypersensitivity reaction induced by erdosteine. Here, we report a case of fixed drug eruption and anaphylaxis, which were concurrently induced by erdosteine. The association between the symptoms and erdosteine was proven by a drug provocation test.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 35-year-old woman presented with recurrent angioedema and pruritic rash on the hands, which developed within 2\u00a0h following the administration of drugs, including erdosteine, for acute upper respiratory infection. Her rash was characterized by well-defined erythematous plaques, which recurred at the same site following the administration of the medications. She also experienced angioedema of the lips. Fixed drug eruption was considered after excluding other possible causes for the presented skin lesions. A drug provocation test confirmed that fixed drug eruption on both hands had occurred after administration of erdosteine, suggesting that erdosteine was the cause of the allergic reaction. However, she also experienced angioedema, isolated wheal, and laryngeal edema; thus, IgE-mediated type I hypersensitivity could also be concurrently occurring with the fixed drug eruption.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We report about a patient who was diagnosed with two different hypersensitivity reactions concurrently induced by erdosteine. We also demonstrate that patients may exhibit multiple simultaneous symptoms that usually arise from overlapping of different hypersensitivity mechanisms. Physicians should be aware of the possibility that some patients who are allergic to certain drugs could exhibit several symptoms caused by different mechanisms of hypersensitivity reactions simultaneously.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13223-021-00517-6","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T04:28:35Z","timestamp":1612758515000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case report"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9723-0720","authenticated-orcid":false,"given":"Da Woon","family":"Sim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji Eun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young-Il","family":"Koh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,5]]},"reference":[{"key":"517_CR1","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.pupt.2017.11.009","volume":"48","author":"M Cazzola","year":"2018","unstructured":"Cazzola M, Calzetta L, Page C, Rogliani P, Matera MG. Impact of erdosteine on chronic bronchitis and COPD: a meta-analysis. Pulm Pharmacol Ther. 2018;48:185\u201394.","journal-title":"Pulm Pharmacol Ther"},{"issue":"Suppl 1","key":"517_CR2","doi-asserted-by":"publisher","first-page":"S70","DOI":"10.1007\/s00408-007-9065-3","volume":"186","author":"RW Dal Negro","year":"2008","unstructured":"Dal Negro RW. Erdosteine: antitussive and anti-inflammatory effects. Lung. 2008;186(Suppl 1):S70\u20133.","journal-title":"Lung"},{"issue":"3","key":"517_CR3","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1586\/17476348.1.3.307","volume":"1","author":"M Moretti","year":"2007","unstructured":"Moretti M. Pharmacology and clinical efficacy of erdosteine in chronic obstructive pulmonary disease. Expert Rev Respir Med. 2007;1(3):307\u201316.","journal-title":"Expert Rev Respir Med"},{"issue":"3","key":"517_CR4","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1517\/17425250902814790","volume":"5","author":"M Moretti","year":"2009","unstructured":"Moretti M. Erdosteine: its relevance in COPD treatment. Expert Opin Drug Metab Toxicol. 2009;5(3):333\u201343.","journal-title":"Expert Opin Drug Metab Toxicol"},{"key":"517_CR5","doi-asserted-by":"publisher","first-page":"117955061882193","DOI":"10.1177\/1179550618821930","volume":"12","author":"F Scaglione","year":"2019","unstructured":"Scaglione F, Petrini O. Mucoactive agents in the therapy of upper respiratory airways infections: fair to describe them just as mucoactive? Clin Med Insights Ear Nose Throat. 2019;12:1179550618821930.","journal-title":"Clin Med Insights Ear Nose Throat"},{"issue":"1","key":"517_CR6","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/s12931-019-1078-y","volume":"20","author":"P Rogliani","year":"2019","unstructured":"Rogliani P, Matera MG, Page C, Puxeddu E, Cazzola M, Calzetta L. Efficacy and safety profile of mucolytic\/antioxidant agents in chronic obstructive pulmonary disease: a comparative analysis across erdosteine, carbocysteine, and N-acetylcysteine. Respir Res. 2019;20(1):104.","journal-title":"Respir Res"},{"issue":"9237","key":"517_CR7","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1016\/S0140-6736(00)02799-9","volume":"356","author":"IR Edwards","year":"2000","unstructured":"Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000;356(9237):1255\u20139.","journal-title":"Lancet"},{"issue":"Suppl 1","key":"517_CR8","doi-asserted-by":"publisher","first-page":"96","DOI":"10.2500\/aap.2012.33.3561","volume":"33","author":"A Uzzaman","year":"2012","unstructured":"Uzzaman A, Cho SH. Chapter 28: classification of hypersensitivity reactions. Allergy Asthma Proc. 2012;33(Suppl 1):96\u20139.","journal-title":"Allergy Asthma Proc."},{"issue":"5","key":"517_CR9","doi-asserted-by":"publisher","first-page":"277","DOI":"10.2165\/00128071-200001050-00003","volume":"1","author":"AY Lee","year":"2000","unstructured":"Lee AY. Fixed drug eruptions. Incidence, recognition, and avoidance. Am J Clin Dermatol. 2000;1(5):277\u201385.","journal-title":"Am J Clin Dermatol."},{"issue":"3","key":"517_CR10","first-page":"277","volume":"68","author":"M Namisato","year":"2000","unstructured":"Namisato M, Ogawa H. Serious side effects of rifampin on the course of WHO\/MDT: a case report. Int J Lepr Other Mycobact Dis. 2000;68(3):277\u201382.","journal-title":"Int J Lepr Other Mycobact Dis"},{"issue":"8","key":"517_CR11","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1097\/SMJ.0b013e3180f60a57","volume":"100","author":"R Luzzati","year":"2007","unstructured":"Luzzati R, Giacomazzi D, Franchi F, Barcobello M, Vento S. Life-threatening, multiple hypersensitivity reactions induced by rifampicin in one patient with pulmonary tuberculosis. South Med J. 2007;100(8):854\u20136.","journal-title":"South Med J"},{"issue":"2","key":"517_CR12","doi-asserted-by":"publisher","first-page":"183","DOI":"10.4168\/aair.2014.6.2.183","volume":"6","author":"DH Kim","year":"2014","unstructured":"Kim DH, Choi YH, Kim HS, Yu JE, Koh YI. A case of serum sickness-like reaction and anaphylaxis\u2014induced simultaneously by rifampin. Allergy Asthma Immunol Res. 2014;6(2):183\u20135.","journal-title":"Allergy Asthma Immunol Res"},{"issue":"3","key":"517_CR13","first-page":"230","volume":"22","author":"WJ Song","year":"2012","unstructured":"Song WJ, Shim EJ, Kang MG, Sohn SW, Kang HR. Severe drug hypersensitivity induced by erdosteine and doxofylline as confirmed by patch and lymphocyte transformation tests: a case report. J Investig Allergol Clin Immunol. 2012;22(3):230\u20132.","journal-title":"J Investig Allergol Clin Immunol"},{"issue":"8","key":"517_CR14","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1111\/j.1398-9995.2007.01421.x","volume":"62","author":"A Muraro","year":"2007","unstructured":"Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, et al. The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Allergy. 2007;62(8):857\u201371.","journal-title":"Allergy"},{"issue":"2","key":"517_CR15","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1038\/clpt.1981.154","volume":"30","author":"CA Naranjo","year":"1981","unstructured":"Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239\u201345.","journal-title":"Clin Pharmacol Ther"},{"issue":"4","key":"517_CR16","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1684\/ejd.2010.0980","volume":"20","author":"N Brahimi","year":"2010","unstructured":"Brahimi N, Routier E, Raison-Peyron N, Tronquoy AF, Pouget-Jasson C, Amarger S, et al. A three-year-analysis of fixed drug eruptions in hospital settings in France. Eur J Dermatol. 2010;20(4):461\u20134.","journal-title":"Eur J Dermatol"},{"issue":"7","key":"517_CR17","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1080\/17512433.2017.1322508","volume":"10","author":"D Garcia","year":"2017","unstructured":"Garcia D, Cohen PR. Dapsone-associated fixed drug eruption. Expert Rev Clin Pharmacol. 2017;10(7):717\u201325.","journal-title":"Expert Rev Clin Pharmacol"},{"issue":"1","key":"517_CR18","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.iac.2014.09.010","volume":"35","author":"KW Williams","year":"2015","unstructured":"Williams KW, Sharma HP. Anaphylaxis and urticaria. Immunol Allergy Clin North Am. 2015;35(1):199\u2013219.","journal-title":"Immunol Allergy Clin North Am"},{"issue":"2","key":"517_CR19","doi-asserted-by":"publisher","first-page":"217","DOI":"10.23736\/S0392-0488.17.05699-1","volume":"154","author":"L Sacchelli","year":"2019","unstructured":"Sacchelli L, Banzola N, Traniello Gradassi A, Patrizi A, D\u2019Antuono A. Can a single drug administration elicit two different immunological pathways at the same time? Fixed drug eruption after anaphylaxis. G Ital Dermatol Venereol. 2019;154(2):217\u20138.","journal-title":"G Ital Dermatol Venereol"},{"issue":"5","key":"517_CR20","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1111\/1346-8138.12473","volume":"41","author":"T Honda","year":"2014","unstructured":"Honda T, Kabashima K, Fujii Y, Katoh M, Miyachi Y. Autoimmune progesterone dermatitis that changed its clinical manifestation from anaphylaxis to fixed drug eruption-like erythema. J Dermatol. 2014;41(5):447\u20138.","journal-title":"J Dermatol"}],"container-title":["Allergy, Asthma &amp; Clinical Immunology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-021-00517-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13223-021-00517-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-021-00517-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T04:30:51Z","timestamp":1612758651000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacijournal.biomedcentral.com\/articles\/10.1186\/s13223-021-00517-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,5]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["517"],"URL":"https:\/\/doi.org\/10.1186\/s13223-021-00517-6","relation":{},"ISSN":["1710-1492"],"issn-type":[{"type":"electronic","value":"1710-1492"}],"subject":[],"published":{"date-parts":[[2021,2,5]]},"assertion":[{"value":"25 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Yes.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Yes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"15"}}