Anaphylaxis case report to trimethylphloroglucinol (Spasfon®)

International audiencePhloroglucinol (P) and its methylated derivative (TMP) are both phenol derivative antispasmodic agents (Fig. 1) acting on smooth muscle and prescribed to treat acute spasmodic abdominal pain, acute painful disorders of the urinary tract, and acute pain in gyne-cology. It has been showed that P and TMP act by reducing glycerol-induced abdominal pain and by inhibiting colonic phasic contractions. 1 Exceptionally, P and TMP are associated with muco-cutaneous manifestations and allergic reactions. It has been reported, in the French National pharmacovigilance database, 21 cases of anaphy-laxis to phloroglucinol, including 16 cases of anaphylactic shock and 5 cases of allergic skin reaction (unpublished data). We report a case of anaphylaxis to phloroglucinol confirmed by skin testing. Case report We report the case of a 23 year old female patient, who has a medical history of mildly active ulcerative colitis treated with mesalamine (Pentasa ®). She had no relevant past surgical history. The patient was evaluated in allergy consultation for a recent generalized facial maculo-papular exanthema associated with dysphonia, dysphagia and mild dyspnea that occurred 6 months ago. In fact, this systemic reaction appeared half an hour after taking Spasfon ® , paracetamol, loperamide and a cough syrup containing codeine (Polery ®), during an influenza-like illness with gastroenteritis. She then presented to the emergency department where she was given intravenous H1 antihistamine plus a single intravenous corticosteroid dose (methylprednisolone 1 mg/kg). Dysphonia, dysphagia and dyspnea improved successfully and she was discharged on oral antihistamine and corticosteroid for 5 days. The facial skin eruption disappeared slowly over 3e4 days. All drugs that have been taken are known to cause allergic reactions as side effects. Also, children and adult can commonly develop urticaria as a result of viral respiratory infections. 2 As this systemic reaction can evoke an immunological IgE mediated mechanism, we decided to test all drugs that were taken on that day. An allergic food reaction is unlikely, given the absence of food intake for at least 6 h before the reaction, and the absence of ingestion of unusual foods within the 24 h before the reaction. Fig. 1. From left to right, and up to down: phloroglucinol, trimebutine, mebeverine, pinaverium