Dexamethasone 0.1% / Tobramycin 0.3% eye drops

BackgroundMannitol is Food and Drug Administration-approved for the reduction of intracranial pressure associated with cerebral edema and the reduction of intraocular pressure and is a commonly used drug in clinical practice. Hypersensitivity to mannitol is rarely reported, and only nine cases have been documented in English since 1967, all of which exhibited a rapid onset. We report a case of delayed anaphylactic shock induced by mannitol, aiming to alert clinical practitioners to the potential occurrence of such rare and serious adverse drug reactions (ADRs).Case presentationA 62-year-old Asian Chinese male patient was administered mannitol to reduce intraocular pressure following eye trauma. He did not report any discomfort during the first five intravenous infusions of mannitol. However, upon the sixth administration, the patient presented with anaphylactic shock, characterized by an abrupt loss of consciousness and hypotension. In response, the intravenous infusion was promptly discontinued, and a balanced salt solution was administered for fluid replacement. Epinephrine was administered to elevate blood pressure, while dexamethasone was utilized for its properties of inhibiting allergic responses. Subsequently, the patient's level of consciousness and blood pressure stabilized.DiscussionWe examined the correlation between anaphylactic shock in patients and mannitol, providing a concise summary of the characteristics noted in previous reports of mannitol-induced allergies. Additionally, we highlighted the distinctions of this particular case through a comprehensive literature review, as well as exploring the potential mechanisms behind delayed drug hypersensitivity reactions attributed to mannitol.ConclusionIt is crucial to be aware of the delayed allergic reactions associated with mannitol. Further post-marketing surveillance studies are necessary to identify rare and unknown adverse drug reactions following therapy with mannitol.

Abstract licence: CC BY-NC-ND