000706 - Severe Anaphylaxis During Gabapentin Drug Provocation Testing in a Patient with Multiple Drug Hypersensitivity

Background

Drug hypersensitivity reactions represent a major challenge in allergology, particularly in elderly patients with multiple comorbidities and a history of anaphylaxis. Although drug provocation tests remain the gold standard for confirming drug tolerance, they carry a significant risk in high-risk patients.

Objectives

To report a case of severe anaphylaxis triggered by an oral gabapentin drug provocation test in a patient with multiple drug allergies, and to highlight safety considerations during diagnostic procedures.

Methods

A 70-year-old female patient with a history of anaphylactic shock to metamizole, urticaria to NSAIDs and carbamazepine, and multiple cardiovascular and neurological comorbidities was admitted for drug allergy evaluation.Skin prick and patch tests were performed for duloxetine, gabapentin, and lamotrigine, all of which were negative. An open oral drug provocation test with duloxetine was well tolerated. Subsequently, an open oral provocation test with gabapentin was conducted under hospital supervision.

Results

Twenty-five minutes after administration of one-third of a gabapentin tablet, the patient developed severe anaphylaxis, characterized by generalized pruritus, urticaria, hypotension, dyspnea, and impaired general condition. Immediate treatment with intramuscular epinephrine and systemic corticosteroids was administered, followed by transfer to the intensive care unit. The clinical course was favorable with full recovery.Previous molecular allergy testing revealed sensitization to soy and insect allergens, and the patient reported prurigo after ingestion of soy-containing foods.

Conclusions

This case highlights:

• the potential for life-threatening reactions during drug provocation testing, even when skin tests are negative;
• the importance of performing such tests exclusively in specialized hospital settings with immediate access to advanced resuscitation;
• the necessity of strict avoidance of gabapentin and related drugs, as well as NSAIDs, in high-risk patients.

Patients with multiple drug allergies and a history of anaphylaxis require an individualized diagnostic approach, and epinephrine auto-injectors remain essential for long-term management