Flare up reactions

Contact allergy to glucocorticoids is not rare in patients with atopic dermatitis. In patients with known contact allergy to budesonide, allergic skin reactions can also occur when inhaled forms of the drug are used, as shown by a randomized, double-bhnd, placebo-controlled study in 15 non-asthmatic patients with budesonide hypersensitivity on patch testing (101). In four of seven patients who used inhaled budesonide, there was reactivation of the 6-week-old patch test sites and they had new distant skin lesions. No flare-up reactions were observed in the other 11 patients (three had used inhaled budesonide and eight placebo for 1 week). None of the patients developed respiratory symptoms spirometry and peak expiratory flow rates remained normal. 

Sanchez TS, Sanchez-Perez J, Aragues M, Garcia-Diaz A. Flare-up reaction of pseudoephedrine baboon syndrome after positive patch test. Contact Dermatitis 2000 42(5) 312-13. 

Topical corticosteroids can be applied in very selected patients with very inflammatory acne for short periods of time. They may play a role in reducing flare-up reactions in severe conglobate acne and for reduction of granuloma pyogenicum-like lesions under systemic isotretinoin treatment. ... 

Hindsen M, Bruze M, Christensen OB (1999) Flare-up reactions after oral challenge with nickel in relation to challenge dose, intensity and time of previous patch test reactions. J Am Acad Dermatol (in press)... 

Liden C, Brehmer-Andersson E (1988) Occupational dermatoses from colour developing agents. Clinical and histopathological observations. Acta Derm Venereol (Stockh) 68 514-522 Liden C, Boman A, Hagelthorn G (1982) Flare-up reactions from a chemical used in the film industry. Contact Dermatitis 8 ... 

Jacob SE, Barland C, ElSaie ML. Patch-test-induced flare-up reactions to neomycin at prior biopsy sites. Dermatitis 2008 19(6) E46-8. 

The most common adverse effects reported with LHRH agonist therapy include a disease flare-up during the first week of therapy, hot flashes, erectile impotence, decreased libido, and injection-site reactions.19 The disease flare-up is thought to be caused by initial induction of LH and FSH by the LHRH agonist and manifests clinically as either increased bone pain or increased urinary symptoms.19 This flare reaction usually resolves after 2 weeks and has a similar onset and duration pattern for the depot LHRH products.33,34... 

The most common adverse effects of LHRH agonists are disease flare-up during the first week of therapy (e.g., increased bone pain, urinary symptoms), hot flashes, erectile impotence, decreased libido, and injection-site reactions. 

Hypersensitivity reactions are uncommon, but they can be severe. Aseptic meningitis, hjrpotension, fever, conjunctivitis, arthralgias, and leukopenia were reported in a woman with systemic lupus erythematosus (2). Other similar patients have experienced fever with rashes, abdominal pain, headache, nausea and vomiting, signs of liver damage, and meningitis. This type of reaction seems to occur especially (but not exclusively) in patients with connective tissue diseases (SEDA-5,105) (SEDA-10, 84) and it can be difficult to differentiate between a hypersensitivity reaction and a flare-up of the disease. Ibuprofen can provoke bronchos-pasm and anaphylaxis in asthmatics (SEDA-22,116). 

Skin reactions, including erythema multiforme in three patients and a lichenoid eruption in one, were attributed to infliximab (17). One patient had similar lesions after etanercept. Patch tests with infliximab in three patients were negative, but produced a flare-up of lesions in one patient and recurrence of malaise and nausea in another patient, suggesting that infliximab is well absorbed per-cutaneously. 

There was at one time impressive but limited case evidence that systemic reactions to iron dextran might be more frequent in patients with rheumatic or other inflammatory diseases no further evidence has been published. There might be confusion with the ability of intravenous iron to induce a flare-up of an existing rheumatic condition (see the section on Oral iron under Musculoskeletal). 

Preservatives such as parabens, i.e., esters ofp-hydroxybenzoic acid are used in the pharmaceutical and cosmetic industry as well as in foods. Allergic reactions to parabens have been reported with increasing frequency from the United States (Fischer 1973). Contact allergy to sorbic acid has also been reported but seems to be rare (Hjort and Trolle-Lassen 1962 Klaschka and Beiersdorff 1965 Fischer et al. 1971 Sadhan and Harman 1978 Brown 1979). That the dermatitis should flare up or get worse after intravenous or oral ingestion of such preservatives has not been reported. 

Precaution Combustible 650 C (solid) flamm., dangerous fire risk (powd.) strong reducing agent dangerous when wet fires flare up violently when moisture is present mod. explosive as dust exposed to flame explosive/violent reactions possible... 

It is well known that carbon-14 is produced in the atmosphere by the reaction of heavy particles, notably neutrons, originating from the sun s activities and atmospheric nitrogen. Although the sun s activities have been subjected to occasional flare-ups, they have been reasonably constant over the last 50,000 years. Various measurements suggest a value of 14.1 0.5 disintegrations per minute (dpm)... 

Some oral provocation tests with high doses of nickel (0.6-5.6 mg, as nickel sulfate) have resulted in aggravation of hand eczema (Christensen and Moller 1975b Cronin et al. 1980 Veien 1989). Flare-ups of patch-test reactions have been provoked by oral challenge (Hindsen et al. 1999). In hand eczema, benefit from a low-nickel diet has been reported in a few open studies (Kaaber et al. 1978 Veien et al. 1993). 

Tobacco blades (moistened). Tobacco blades were negative in 15 controls. However, strongly positive (++) reactions only should be considered. A flare-up of the previous dermatitis during patch testing is of value to distinguish between allergic and irritant patch test reactions (Le Coz et al. 1997)... 

Systemic and cutaneous reactions have been reported following administration of infliximab. These include anaphylaxis, serum sickness, maculopapular rashes, urticaria, psoriasis, flare-up of atopic dermatitis, and leukocytoclastic vascuhtis. The overall incidence of infusion reactions in one study was 6.1 %. Mild, moderate, and severe reactions occurred in 3.1, 1.2, and 1 % of infliximab infusions, respectively. Patients with lymphocyte counts greater than 50 XIQP/L experienced a severe cytokine release syndrome shown by peaks in release of TNF and lL-6 90 min after infusion with rituximab. A number of post-infusion hypersensitivity or hypersensitivity-like reactions occur to rituximab. These reactions include serum sickness, vasculitis, various cutaneous manifestations, interstitial pneumonitis, and acute respiratory distress syndrome. 

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