Codeine caused pruritic scarlatiniform exanthemata: patch test negative but positive to oral provocation test

Abstract

Sir, Codeine was first extracted from opium in 1832, and in 1882 its chemical formula was determined to be the methyl ester of morphine. Despite extensive use as an analgesic and antitussive drug, clear‐cut cases of codeine‐induced exanthemata are rare.1 Török, in a 10‐year observation period of ‘dermatitis medicamentosa’, found only 15 of 1303 cases to be elicited by codeine.2 We report the case of a 58‐year‐old non‐atopic male Caucasian who developed a pruritic rash affecting body and face and periorbital swelling 3 h after the ingestion of codeine 20 mg, acetylcysteine 600 mg and acetylsalicylic acid 500 mg because of influenza. There was no other history of allergic drug reactions. Previous intake of the medication had been well tolerated. The patient reported to our allergy unit 10 months later. Clinical examination demonstrated an obese patient (body mass index (BMI) 27·1 kg m−2 normal BMI range, 18·5–24·9 kg m−2) with normal appearing skin.