Use of Antihistamines After Serious Allergic Reaction to Methimazole in Pediatric Graves’ Disease
Abstract
Antithyroid drugs are usually considered first-line therapy for management of pediatric Graves’ disease because they avoid permanent hypothyroidism, provide a chance for remission, and are less invasive than the alternatives of thyroidectomy or radioactive iodine. Methimazole (MMI) is the only antithyroid drug recommended in pediatrics due to the risk of propylthiouracil-induced liver toxicity. Allergic reactions with MMI occur in up to 10% of patients and, when mild, can be managed with concurrent antihistamine therapy. Guidelines recommend discontinuation of MMI with serious allergic reactions. We present the case of an adolescent girl with Graves’ disease and a serious allergic reaction after starting MMI whose family refused radioactive iodine and was reluctant to proceed to surgery. Antihistamine therapy was successfully used to allow continued treatment with MMI. This case demonstrates extension of management guidelines for minor cutaneous allergic reactions to MMI, through the use of antihistamines for a serious allergic reaction, allowing us to continue MMI and provide treatment consistent with the family’s preferences and values.
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A case report described a severe reaction to MMI consisting of rash, pruritis, and tongue and throat swelling that was successfully managed with antihistamine therapy, but this is not generally recommended because of the risk of anaphylaxis.
“One recent case report described a more severe reaction to MMI consisting of rash, pruritis, and tongue and throat swelling that was successfully managed with antihistamine therapy, but this is not generally recommended because of the risk of anaphylaxis (162).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [162]
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“One recent case report described a more severe reaction to MMI consisting of rash, pruritis, and tongue and throat swelling that was successfully managed with antihistamine therapy, but this is not generally recommended because of the risk of anaphylaxis (162).”
Background
- Authors
- Toderian, A. B., & Lawson, M. L.
- Affiliations
- Faculty of Medicine, and
- University of Ottawa (CA)
- ORCID
- Lawson, Margaret L.
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2014-05-01
- Volume
- 133
- Issue
- 5
- Pages
- e1401-e1404
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2098224575
- Cited by
- 10
- References
- 16
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 2 · 2021: 2 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 1
- FWCI
- 1.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- methimazole, antihistamines, drug hypersensitivity, allergic reactions, pediatric Graves' disease, antithyroid drugs, propylthiouracil, drug-induced skin reaction, treatment continuation, patient and family preferences
- MeSH terms
- Adolescent, Diphenhydramine, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Hypersensitivity, Female, Graves Disease, Histamine H1 Antagonists, Humans, Methimazole, Antithyroid Agents, Treatment Outcome
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