Rapid desensitization to doxycycline

Abstract

A 48-year-old woman had a well-documented history of an anaphylactic reaction to doxycycline prescribed for the treatment of a febrile illness associated with headache, myalgia, facial pain, and cervical lymphadenopathy. She presented to the Emergency Department 15 minutes after taking her first dose, with generalized urticaria, facial angioedema, throat constriction, hoarseness, shortness of breath, and expiratory wheeze. The reaction was promptly reversed with intramuscular administration of epinephrine and inhalation of high-flow oxygen and nebulized salbutamol. She was able to tolerate doxycycline previously. Her prolonged febrile illness was eventually diagnosed as Q fever, and 4 months after her anaphylaxis and failure to respond to an empirical trial of other antimicrobial agents a request for desensitization was made by the treating physician. However, no such protocol was available in the literature.