Ticagrelor-induced hypersensitivity reaction

Reacción de hipersensibilidad a ticagrelor

Ticagrelor is an antiplatelet therapy used for secondary prevention in patients with acute coronary syndrome. Adverse effects of ticagrelor are hemorrhage, headache, dyspnea, epistaxis, ventricular pauses or bradycardia, hyperuricemia and elevation of creatinine level. However, hypersensitivity reaction of ticagrelor is rarely recognized. We present a 63-year- old male patient diagnosed with acute myocardial infarction, ST-segment elevation and ectasia and low blood flow disease documented by coronary angiogram. He required dual antiplatelet therapy with acetylsalicylic acid (ASA) and ticagrelor, developing drug-induced urticaria according to dermatology consultation. He was treated with topical steroids, oral antihistamines and ticagrelor discontinuation. This case is considered a rare case of reaction to the antiplatelet agent described herein.

1. Badimon L, Mendieta G, Vilahur G. Diferencias en los mecanismos de acción de los nuevos antiagregantes: ¿cómo actúan?. Rev Esp Cardiol Supl. 2014;14:3-9.
2. Centro Andaluz de Documentación e Información de Medicamentos. Informes de evaluación de medicamentos. Ticagrelor España: Centro Andaluz de Documentación e Información de Medicamentos (CADIME); 2013. p. 52.
3. Ikram S, Veerappan Kandasamy V. Ticagrelor-induced Sweet Syndrome: an unusual dermatologic complication after percutaneous coronary intervention. Cardiovasc Interv and Ther. 2017;32(3):244-6. doi: 10.1007/s12928-016-0398-9.
4. Quinn KL, Connelly KA. First report of hypersensitivity to ticagrelor. Can J Cardiol. 2014;30(8):957 e3-4. doi: 10.1016/j. cjca.2014.04.011.
5. Dai J, Lyu S, Ge C. Hypersensitivity to ticagrelor and low response to clopidogrel: a case report. Asia Pacific allergy. 2017;7(1):51-3. doi: 10.5415/apallergy.2017.7.1.51.
6. Jacobson KA, Boeynaems JM. P2Y nucleotide receptors: promise of therapeutic applications. Drug discovery today. 2010;15(13- 14):570-8. doi: 10.1016/j.drudis.2010.05.011.
7. Chin N, Rangamuwa K, Mariasoosai R, Carnes J, Thien F. Oral antiplatelet agent hypersensitivity and cross-reactivity managed by successful desensitisation. Asia Pac Allergy. 2015;5(1):51-4. doi: 10.5415/apallergy.2015.5.1.51.