Hypersensitivity minocycline

Antunes A, Davril A, Trechot P, Grandidier M, Truchetet F, Cuny JF. Syndrome d hypersensibilite a la minocycline. [Minocycline hypersensitivity syndrome.] Ann Dermatol Venereol 1999 126(6-7) 518-21. 

The authors stated that they did not have any clear information about the absolute and relative risks of hepatitis, whether these were hypersensitivity reactions or autoimmune hepatitis, in patients taking minocycline for varying lengths of time, and that a study of the comparative rates of hepatitis in people exposed to minocycline compared with those not exposed is required. In the meantime, new reports of severe hepatic reactions to minocycline continue to appear (15-17), including one case of autoimmune hepatitis requiring liver transplantation in a woman who had used minocychne 50-200 mg/ day for 3 years (17). Another case of liver transplantation has previously been reported in patients with hepatic failure after minocycline therapy (18). 

Immunoallergic reactions have been reported with minocycline and include lupus-like syndrome, autoimmune hepatitis, eosinophilic pneumonia, hypersensitivity syndrome, a serum sickness-like illness (29), and Sweet s syndrome (SEDA-21, 262) (SEDA-22, 271). Over 60 minocycline-induced cases of lupus-like syndrome and 24 cases of minocycline-induced autoimmune hepatitis were found in a review of the literature (30). In 13 patients, both disorders co-existed. These patients had symmetrical polyarthralgia/polyarthritis, raised liver enzymes, and positive antinuclear antibodies they were also generally antihistone-negative, and only two patients had p-ANCA antibodies. Minocycline-related lupus can also occur in adolescents (31). 

Allergic reactions to tetracyclines are less than half as common as allergic reactions to penicillin. For this reason, tetracyclines are alternatives in patients with allergic reactions to other antibiotics. Exceptional observations of anaphylactic shock have been reported (37,38). In a few cases tetracychnes were assumed to be the cause of hypersensitivity myocarditis (39). Pneumonitis with eosinophiha has been described in association with tetracychnes (40). A serum sickness-hke syndrome was probably associated with minocycline in a 19-year-old man treated for acne (41). Allergic and toxic reactions may in some cases have been caused by degraded formulations or additives (42). Tumor-inducing effects have not been reported. 

Vinson AE, Dufort EM, Willis MD, Eberson CP, Harwell JI. Drug rash, eosinophilia, and systemic symptoms syndrome two pediatric cases demonstrating the range of severity in presentation—a case of vancomycin-induced drug hypersensitivity mimicking toxic shock syndrome and a milder case induced by minocycline. Pediatr Crit Care Med 2010 11(4) e38-43. 

The pathogenesis of minocycline-induced hypersensitivity is unknown. Although it is not known for certain that minocycline has... 

Brown RJ, Rother KI, Artman H, Mercuric MG, Wang R, Looney RJ, Cowen EW. Minocycline-induced drug hypersensitivity syndrome followed by multiple autoimmune sequelae. Arch Dermatol 2009 145(1) 63-6. 

Shapiro LE, Knowles SR, Shear NH. Comparative safety of tetracycline, minocycline, and doxycycline. Arch Dermatol 1997 133 1224-1230. de Paz S, Perez A, Gomez M, et al. Severe hypersensitivity reaction to minocycline. J Investig Allergol Clin Immunol 1999 9 403-404. 

GuiUon JM, Joly P, Autran B, et al. Minocycline-induced cell-mediated hypersensitivity pneumonitis. Ann Intern Med 1992 117 476-481. 

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