Urticaria vitamin

Other colourants in use are sunset yellow (Eiio), another synthetic azo dye, and caramel. Caramel colours are manufactured from sugars and are very widely used. This food colour has caused some concern due to effects in experimental animals, for example the reduction in the number of white blood cells in rats. This may be due to the effects of contaminants at the high doses given which may be enhanced by a reduced intake of vitamin B6 in the diet. Annatto and beta carotene are naturally occurring colourants, but in one study 26 per cent of patients with chronic urticaria were shown to react to annatto. 

The observation of a chronic urticaria in two sisters who excreted abnormal amounts of xanthurenic acid after a 10-g DL-tryptophan load indicated to Knapp et al. (K6) that constitutional genetic factors may be involved in vitamin Bg-deficiency symptoms. This was borne out by a very high xanthurenic acid level during a similar test on another family. 

In subsequent studies (K7), 9 members of 3 different families were loaded with 10 g OL-tryptophan which resulted in a 10-20-fold increase in the 24-hour urinary excretion of kynurenine, 3-hydroxykynurenine, and xanthurenic acid. It appears to be a genetically conditioned disturbance, with dominant inheritance, involving metabolic reactions dependent upon pyridoxine. In most subjects the urinary changes after tryptophan loading could be corrected by vitamin Be therapy. The following diseases were found in this order of frequency in these subjects and their families bronchial asthma, chronic urticaria, anemia, diabetes, arices, and crural ulcers. Knapp s (K7) conclusion is that these disorders may be partially attributable to metabolic disturbances. 

All the cobalamins have the same pattern of adverse reactions. The adverse effects of high doses of cobalamins include urticaria, eczematous and exanthematous skin lesions, and anaphylactic reactions (SEDA-4, 265), but it is not clear whether the reactions are caused by the drug itself, a preservative, or possibly by contaminants. High oral or parenteral doses of vitamin Be and especially hydroxocobalamin are also on rare occasions suspected to induce acne which is, however, always benign (SEDA-5, 347) (1). Several cases of vitamin Bi2-induced folliculitis and acneiform eruptions have been described, in one case in connection with a patient receiving total parenteral nutrition (2). 

Kassen B, Mitchell JC (1974) Contact urticaria from a vitamin E preparation in two siblings. Contact Dermatitis Newslett 16 482... 

Another possible explanation of the observed reactions are the additives in pharmaceutical preparations. Thus Lagerholm et al. (1958) reported a case of hypersensitivity to benzyl alcohol added as a preservative to vitamin B 2 preparations, resulting in urticaria after injection, Hovding (1968), however, was not able to demonstrate a positive skin reaction either with benzyl alcohol or with cobalt chloride. However, skin tests with commercial brands of cyanocobalamin and hydroxocobalamin as well as with purified cyanocabalamin and hydroxocobalamin were positive. Malten (1975) reports a flare reaction in a woman due to the third injection of 250 pg vitamin B12. Prick and patch tests, however, remained negative. A recent short review of reactions after administration of vitamin Bj2 preparations was published by Meuwissen (1978). An extensive review covering the literature up to 1975 was presented by Faivre et al. (1975). The authors conclude that, despite the widespread use of vitamin B12 preparations, cases of accidents after vitamin Bi2 administration are very rare, but nevertheless are a potential risk. Therefore, skin and immunologic tests should be made prior to administration and especially parenteral application of the vitamin. The authors do not make an explicit statement as to a definite allergic mechanism of the observed phenomena. 

Cases of allergic reactions to ascorbic acid are very rare. Early observations reported rubelliform, morbilliform, and scarlatiniform exanthemas, urticaria, and edema after vitamin C use (Widenbauer 1936a,b). Positive skin reactions were reported by Rust (1954) in seven cases and by Panzani (1961) in one case. In this latter case, the skin test was a passive transfer test (Prausnitz-Kiistner) but the data presented are too scarce to demonstrate a definite immunological etiology of the observed reactions. The same holds for three cases of respiratory and cutaneous allergy reported recently by Vassal (1975). 

A 37-year-old male patient with multiple sclerosis and a vitamin B12 deficiency experienced urticaria... 

Thirty minutes after the last dose, the patient developed urticaria (without angioedema), arterial hypotension or wheezing. Methylprednisolone and chloropyramine were administered, and the urticaria resolved. Prick, intradermal, and provocation tests with cyanocobalamin were negative. Neither of the preparations of vitamin Bi2 that we used contained benzyl alcohol. The patient later received cyanocobalamin on four occasions xmder observation, without any sign of an allergic reaction. Therapy with cyanocobalamin was continued for the next 12 months without any allergic reactions. 

The effect of intravenous vitamin C administration in the management of shingles has been evaluated in a 12-week prospective cohort study. Adverse effects were reported as not serious and included itching, burning sensation at the injection site followed by paraesthesia, and drug-induced urticaria [26 ]. 

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