A Case of Codeine Induced Urticaria/Angioedema

Abstract

A 26-year-old female patient had complained of generalized urticaria with perioral and periorbital angioedema within 30 minutes after taking 20 mg of codeine phosphate. She had suffered from allergic rhinitis sensitized to animal danders, tree and weed pollens. Skin prick test (SPT) and basophil histamine release test with codeine phosphate (0.1, 1 and 10 mg/mL) were done with cytochrome P4502D6 (CYP2D6) genotyping. The skin prick test showed that the wheal/ erythema size of codeine phosphate (10 mg/mL) and morphine (10 mg/mL) were 3×2/14×7 and 3×2/15×8 mm, when compared to that of histamine (4×3/22×19 mm). The results of CYP2D6 genotype revealed that she has CYP2D6*10B/ *10B allele which means decreased turnover to morphine. Histamine releasing ability in response to codeine phosphate were ennanced in a dose-dependent manner (11.47% in 0.1 mg/mL, 62.84% in 1 mg/mL and 91.74% in 10 mg/ mL, respectively), while minimal histamine release was shown in control basophils. To the best of our knowledge, this is the first case of codeine-induced urticaria/angioedema, which has been caused by direct histamine releasing effect of codeine itself in Korea.