Desipramine Acute hypersensitivity reaction [j]

Five weeks before admission, a 52-year-old man with a 20-year history of allergic rhinitis treated with immunotherapy and a history of mild hypertension and coronary artery disease, began treatment with desipramine 200 mg/day for a situational depressive disorder. The patient had no prior history of asthma, pneumonia or chronic lung disease. Two weeks before admission, chest congestion, cough, diarrhoea, myalgias, arthralgias, and recurrent fevers (102°F) developed. One day after noting increased shortness of breath and wheezing the patient was admitted with BP 120/70mm Hg, pulse 78/min, respiration 20/min and unlaboured, temperature 36.5°C and no evidence of adenopathy or rash.

Haemoglobin was 16.5 g/dl and white blood cell count was 19,700/ mm3 (neutrophils 38%, eosinophils 40%). Chest radiograph revealed no active disease Serum IgE was 1920 IU/ml, serum IgG, IgM and IgA concentrations were within normal limits, sedim~ntation rate was 23 mm/ hour, antinuclear antibody was absent, total haemolytic complement, C3 and C4 were normal and rapid plasma reagin was negative Desipramine treatment was stopped and an IV infusion of aminophylline and inhaled iJ-adrenergic agonlsts rapidly resolved the patient's symptoms.

'The clinical course and data in our patient strongly suggest either a type I mediated Immune reaction to desipramine or direct mediator release Induced by circulating desipramine.'

Panuska JR, King TR, Korenblat PE, Wedner HJ Journal of Allergy and Clinical Immunology 80 18· 23, Jul 1987

0157-7271/87/1003-0007/0$01.00/0 © ADIS Press REACTlONS~ 3 October 1987 7