Severe adverse drug reactions due to pseudoephedrine from over-the-counter medications.

A 68-year-old man presented with a generalized papular eruption with oedema of the face and the hands, fever and pustulosis in intertriginous areas which had begun 1 day after starting treatment with EuvanolA nasal spray (plant extracts and benzalkonium chloride) and DolirhumA (paracetamol and pseudoephedrine). He has been hospitalized 8 years before for a similar eruption associated with hyperleucocytosis, eosinophilia and superficial pustules on biopsy. A diagnosis of acute generalized exanthematous pustulosis had been made and the patient advised to avoid nonsteroidal anti-inflammatory and blactam antibiotic drugs, because the eruption had appeared on piroxicam and cefatrizine. No such advice had been provided about a nasal decongestant (RhinalairA Ω pseudoephedrine), a 3rd drug that had been taken by the patient. Patch tests were performed 2 months after the 2nd eruption with cefatrizine, piroxicam, paracetamol, benzalkonium chloride and pseudoephedrine. The only positive test was to pseudoephedrine (10% pet.) (ππD2,ππD4).