Allergy to quinine and tonic water

Abstract

Quinine is an alkaloid extracted from cinchona bark and used principally to treat malaria. It has anti-malarial activity and is used to treat muscle cramps and influenza infections. It can also be used as an appetite stimulant and anti-asthenic agent. It is a component of several antipyretic and antalgic drugs. Quinine is also an ingredient of regularly absorbed tonic waters. Several immuno-allergic reactions have been related to quinine, among them cytopenia, hemolytic uremic syndrome, photosensitivity, hepatitis, vasculitis, and contact dermatitis [ 1,2]. Case reports of anaphylactic reactions to quinine are rare in the literature [3-51. We report here the case of a young woman who initially presented with allergy after taking a medicinal product containing quinine and who then had two episodes of anaphylactic shock after drinking a glass of tonic water containing quinine. The patient was a 20-year-old woman. She came to our hospital in 2001 for a consultation to evaluate two reactions consisting of generalized urticaria and respiratory discomfort that she related spontaneously to drinking tonic water (‘Schweppes’), a drink she did not drink regularly. In her personal health notebook there was a report of generalized urticaria, laryngeal angioedema, and a drop in blood pressure after taking CCquinil@ in 1994 for a bout of flu. The medication was contra-indicated, but no immunoallergic evaluation was performed at the time. In July 2001, 15 min after drinking a glass of ‘Schweppes’, she experienced sneezing, urticaria, respiratory discomfort, and a feeling of chest oppression, all of which