Allergic
Conjunctivitis
BY
G.
ELMAR
LUTZ,
Due
to Diazepam
M.D.
The author reports onfourpatients. all women, who developed conjunctival hypersensitivity during diazepam treatment. This hypersensitivity is self-limited after diazepam treatment is discontinued. The author suggests that conjunctival hypersensitivity could be mistakenly attributed to contact lens irritation rather than to diazepam.
HYPERSENSITIVITY
to
REACTIONS
benzodiazcpines
are
virtually unknown ( I ). This fact, in addition to their dinical effectiveness and their extreme safety (successful suicidcs with bcnzodiazepines are rare), may account for the widespread use of benzodiazcpines, especially diazcpam (Valium). It has been my experience that there is a hypersensitivity
reaction
fairly
specific
for
diazepam.
During
the past three years, four women (aged 23, 38, 47, and 52) with allergic conjunctivitis came to my attention during the course of psychiatric treatment. All reported marked conjunctival burning, smarting, and foreign body sensations within 1/2 hour after intake of 5 to 10 mg of diazepam. In addition, three of these women reported associated light sensitivity. Interestingly, there were no complaints of itching. Examination revealed marked conjunctival injection. The discomfort seemed to have a peak duration of 4 hours, subsiding gradually within 24 to 48 hours following a single 5- or 10-mg oral test dose of diazepam and coinciding approximately with the plasma
half-time
(21
of elimination
pam and its primary metabolites, thyldiazepam (2). (Diazepam and
to 37 hours) oxazepam and its metabolites
Dr. Lutz is Senior
548
Attending Hospital, Passaic, Rd., Wayne, N.J.
AmJ
Psychiatry
Psychiatrist, N.J. Address 07470.
132:5.
May
can
women til
be annoying
ingested
the
who
wore
nosed
as
socially
having
social
was
lenses
diazepam,
embarrassing-all
before
relationship
contact to
and
diazepam
causative
sensitivity
might
conjunctival
four
engagements
recognized.
developed he
contact lens. This specific hypersensitivity pam treatment is discontinued. can be alleviated by the use chloride (Visine) eycdrops.
desmecan be
Department of Psychiatry, reprint requests to him
1975
tion
conjunctival be
irritation
un-
If a person
hyper-
erroneously
diag-
caused
is self-limited The subjective of tetrahydrozolinc
by
the
after diazediscomfort hydro-
of diaze-
detected in the human body up to 7 days following a single dose.) All four patients using 5 to 10 mg of diazepam one to three times daily had continuous conjunctivitis during
St. Mary’s 896 Valley
diazepam treatment before the connection with diazepam was discovered. I eliminated other possible causes, ineluding sensitivity to eye make-up and cigarette smoke. Repeated single-dose provocation in each instance led to a predictable recurrence of conjunctival vascular engorgement. One woman had an existing allergic diathesis to grass and to tree pollen; she was also hypersensitive to penicillin. None of the women displayed associated skin or systemic allergic effects. Because of my limited experience, I cannot hypothesize about possible cross-sensitivity to other benzodiazcpines. Clorazepate dipotassium (Tranxene) in one woman did not cause any conjunctival irritation. It is possiblc that conjunctival hypersensitivity is specific for diazepam; sensitization to diazepam seems to have occurred rapidly in all these patients. Although not previously reported, conjunctival hypersensitivity to diazepam may be quite common. This reac-
at
REFERENCES I. 2.
Bookman P: Personal communication, Nov 7, 1974 Kaplan SA, Jack LM, Alexander K, et al: Pharmacokinetic of diazepam in man following single intravenous and chronic oral administrations. J Pharm Sci 62:1789-1796,
profile oral and 1973
Conjunctivitis
BY
G.
ELMAR
LUTZ,
Due
to Diazepam
M.D.
The author reports onfourpatients. all women, who developed conjunctival hypersensitivity during diazepam treatment. This hypersensitivity is self-limited after diazepam treatment is discontinued. The author suggests that conjunctival hypersensitivity could be mistakenly attributed to contact lens irritation rather than to diazepam.
HYPERSENSITIVITY
to
REACTIONS
benzodiazcpines
are
virtually unknown ( I ). This fact, in addition to their dinical effectiveness and their extreme safety (successful suicidcs with bcnzodiazepines are rare), may account for the widespread use of benzodiazcpines, especially diazcpam (Valium). It has been my experience that there is a hypersensitivity
reaction
fairly
specific
for
diazepam.
During
the past three years, four women (aged 23, 38, 47, and 52) with allergic conjunctivitis came to my attention during the course of psychiatric treatment. All reported marked conjunctival burning, smarting, and foreign body sensations within 1/2 hour after intake of 5 to 10 mg of diazepam. In addition, three of these women reported associated light sensitivity. Interestingly, there were no complaints of itching. Examination revealed marked conjunctival injection. The discomfort seemed to have a peak duration of 4 hours, subsiding gradually within 24 to 48 hours following a single 5- or 10-mg oral test dose of diazepam and coinciding approximately with the plasma
half-time
(21
of elimination
pam and its primary metabolites, thyldiazepam (2). (Diazepam and
to 37 hours) oxazepam and its metabolites
Dr. Lutz is Senior
548
Attending Hospital, Passaic, Rd., Wayne, N.J.
AmJ
Psychiatry
Psychiatrist, N.J. Address 07470.
132:5.
May
can
women til
be annoying
ingested
the
who
wore
nosed
as
socially
having
social
was
lenses
diazepam,
embarrassing-all
before
relationship
contact to
and
diazepam
causative
sensitivity
might
conjunctival
four
engagements
recognized.
developed he
contact lens. This specific hypersensitivity pam treatment is discontinued. can be alleviated by the use chloride (Visine) eycdrops.
desmecan be
Department of Psychiatry, reprint requests to him
1975
tion
conjunctival be
irritation
un-
If a person
hyper-
erroneously
diag-
caused
is self-limited The subjective of tetrahydrozolinc
by
the
after diazediscomfort hydro-
of diaze-
detected in the human body up to 7 days following a single dose.) All four patients using 5 to 10 mg of diazepam one to three times daily had continuous conjunctivitis during
St. Mary’s 896 Valley
diazepam treatment before the connection with diazepam was discovered. I eliminated other possible causes, ineluding sensitivity to eye make-up and cigarette smoke. Repeated single-dose provocation in each instance led to a predictable recurrence of conjunctival vascular engorgement. One woman had an existing allergic diathesis to grass and to tree pollen; she was also hypersensitive to penicillin. None of the women displayed associated skin or systemic allergic effects. Because of my limited experience, I cannot hypothesize about possible cross-sensitivity to other benzodiazcpines. Clorazepate dipotassium (Tranxene) in one woman did not cause any conjunctival irritation. It is possiblc that conjunctival hypersensitivity is specific for diazepam; sensitization to diazepam seems to have occurred rapidly in all these patients. Although not previously reported, conjunctival hypersensitivity to diazepam may be quite common. This reac-
at
REFERENCES I. 2.
Bookman P: Personal communication, Nov 7, 1974 Kaplan SA, Jack LM, Alexander K, et al: Pharmacokinetic of diazepam in man following single intravenous and chronic oral administrations. J Pharm Sci 62:1789-1796,
profile oral and 1973
