CASE
An 18-year-old female patient has been diagnosed with asthma, allergic
rhinitis and AD since childhood. The patient, whose asthma was under
control, was using nasal antihistamine, nasal steroid and oral
levocetirizine + montelukast combination for allergic rhinitis.
In the skin prick test (SPT) of the patient, who did not have any
features in the physical examination, sensitivity to mite, grass pollen,
dog, rye was detected.It was decided to start subcutaneous
allergen-specific immunotherapy for grass pollen and house dust mite
before the season, for the patient who did not want to use drugs for a
long time.In blood tests performed before treatment, hemogram, kidney
and liver function tests were normal. Total IgE: 1078 IU/ml, specific
IgE (D1 ptero): 42.7 KU/L, specific IgE (D2 farin): 77.1
KU/L.Allergen-specific immunotherapy was initiated for grass pollen and
house dust mite before the season in accordance with the simultaneous
cluster dose scheme. For pollen, 0.1 ml was injected from bottle A
(1,000 TU/ml), and for house dust mite 0.7 ml was injected from bottle
no. 1 (50 TU/ml).
A day or two after the first injection, the patient started with
widespread redness, itching and burning complaints on the face and
cheeks, and within a week, dry lesions occurred on the face of the
patient (Figure 1).The patient’s complaint of atopic dermatitis
increased and the lesions were thought to be infected.AIT was stopped.
The patient was consulted with dermatology. Anti-HSV Type 1 IgM was
found positive in the blood test, and IgG was negative.There was no
growth in the wound swab culture. With the diagnosis of eczema
herpeticum, amoxicillin+clavulanic acid 1000 mg 2*1 oral, acyclovir 250
mg 3*1 iv, acyclovir topical treatment was started and completed in 10
days. Skin lesions gradually regressed in the patient’s follow-ups.The
lesions disappeared completely after about 1 month (Figure 2). AIT was
not repeated for allergic rhinitis, medical treatment was continued.