Hypereosinophilia with rash to dobutamine infusion ; sulfite hypersensitivity diagnosed by in vitro stimulation assays

• Published in: Allergology International Vol. 65; no. 4; pp. 477 - 480
• Main Authors: Sung-Yoon Kanga, b, e, Ji-Won Leeb, Da-Eun Parkb, Bo-ram Baeb, Hyun-Seung Leeb, Byung-Keun Kima, Ju-Young Kima, Kyung-Hwan Limc, Heung-Woo Parka, Bon-Kwon Kooa, d, Sang-Heon Choa, Woo-Jung Songa
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY OF ALLERGOLOGY 01.10.2016
• ISSN: 1323-8930

[Dear Editor, ] [Introduction] Dobutamine is a widely prescribed form of inotropic support for patients with heart failure, but infusion thereof has been associated with hypersensitivity reactions, namely eosinophilia or eosinophilic myocarditis. However, it remains unclear whether the true culprit is dobutamine per se or its excipient, sulfite. We report a case of recurrent hypereosinophilia with a skin rash that developed during dobutamine infusion. We used an in vitro flow cytometric assay to show that the hypersensitivity was attributable to sulfite. [Case] A 74-year-old male presented to the allergy clinic with hypereosinophilia (2955/mm3) and a generalized morbiliform rash. He had been hospitalized for aggravated heart failure 2 weeks prior, and had been under supportive management that included dobutamine infusion. He had multiple comorbid illnesses, including diabetes mellitus, three-vessel disease, and chronic obstructive pulmonary disease. His initial problems on admission, including dyspnea and edema, gradually improved with supportive management. However, his blood eosinophil count began to increase on hospital day (HD) #5, and a rash developed on HD#12.