Side-effects of atropine: pharmacological, allergic, pseudo-allergic or toxic reactions?

Abstract

Between 1979 and 1981 31 children aged from one to 14 years who had been given atropine eye drops to measure refraction presented with the following side-effects: increased temperature (9/31), dry red skin (8/31), reddened eye (3/31) and periorbital dermatitis (2/31) after single (22/31) or repeated (9/31) administration of atropine. In the epicutaneous test with atropine eye drops 1% (readings after 24, 48 and 72 hours) not a single child showed an allergic or toxic reaction. The rarity of an allergy after administration of atropine drops is emphasized by the fact that periorbital dermatitis was observed in only two cases. Clinical experience shows that incipient allergy owing to the anatomical structure of the conjunctiva and eye lids first becomes apparent in the region of the eye, even if the epicutaneous test is not necessarily positive in the dorsum skin. In view of the necessity of administering atropine prior to emergency surgery it is advisable to carry out epicutaneous tests if side-effects have been observed in the eye, to make sure that the patient is not allergic to the drug.