1094
of difficult cost/benefit analysis but with major unanswered questions left the day of the controlled hypertensive drug trial is far
matter
from over. Department of Geriatric Medicine, Nunnery Fields Hospital, Canterbury CT1 3LP, UK
M. L.
JENKINSON
1. Antiplatelet Trialists’ Collaboration. Secondary prevention of vascular prolonged antiplatelet treatment. Br Med J 1988; 296: 320-31.
Immediate
disease
by
hypersensitivity to aztreonam
SIR,-Aztreonam, because its structure differs considerably from that of the other beta-lactam antibiotics, is said to show very little cross-immunogenicity’—ie, it could be used in patients allergic to penicillins or cephalosporins.2 We have seen a patient with a history of hypersensitivity to penicillin and its derivatives who had an immediate hypersensitivity reaction to her first exposure to 66-year-old diabetic
hypoglycaemic
woman,
who
was
on
Departments of Endocrinology and Internal Medicine,
University Hospital Leiden,
Clinical Pharmacology Service, Internal Medicine Department, and Haematology Service,
J. SOTO ALVAREZ J. A. SACRISTAN DEL CASTILLO I. SAMPEDRO GARCIA M. J. ALSAR ORTIZ
Hospital Marqués de Valdecilla, 39008 Santander, Spain
1. Saxon A, Beall GN, Rohr AS, Adelman DC. Immediate hypersensitivity reactions to beta-lactam antibiotics. Ann Intern Med 1987; 107: 204-15. 2. Donowitz GR, Mandell GL. Beta-lactam antibiotics. N Engl J Med 1988; 318: 490-500. 3. Saxon A, Hassner A, Swabb EA, Wheeler B, Adkinson NF Jr. Lack of cross-reactivity between aztreonam, a monobactam antibiotic, and penicillin-allergic subjects. J Infect Dis 1984; 149: 16. 4. Assem ESK. Drug allergy. Current Opinion Immunol 1989; 1: 660-66.
Spironolactone for porphyria cutanea tarda associated hirsutism SIR,-Porphyria cutanea tarda is often associated with hirsutism or hypertrichosis. Neither the cause of this hirsutism nor any relation to androgen metabolism is known. The only treatment for this often disfiguring hirsutism is cosmetic (eg, shaving or depilatory procedures). A 36-year-old woman who has had porphyria cutanea tarda since the age of 27, had had for the previous 8 years progressive hair growth on her face and thighs and she had to shave twice daily. Her hair growth score (Feriman and Gallwey) was 14, normal being below 7. No other signs of virilism were found. Extensive hormone testing revealed no androgen excess or any other endocrine disorder. The androsterone/aetiocholanolone ratio and the excretion of androstanediol glucuronide were normal, indicating that increased 5
of difficult cost/benefit analysis but with major unanswered questions left the day of the controlled hypertensive drug trial is far
matter
from over. Department of Geriatric Medicine, Nunnery Fields Hospital, Canterbury CT1 3LP, UK
M. L.
JENKINSON
1. Antiplatelet Trialists’ Collaboration. Secondary prevention of vascular prolonged antiplatelet treatment. Br Med J 1988; 296: 320-31.
Immediate
disease
by
hypersensitivity to aztreonam
SIR,-Aztreonam, because its structure differs considerably from that of the other beta-lactam antibiotics, is said to show very little cross-immunogenicity’—ie, it could be used in patients allergic to penicillins or cephalosporins.2 We have seen a patient with a history of hypersensitivity to penicillin and its derivatives who had an immediate hypersensitivity reaction to her first exposure to 66-year-old diabetic
hypoglycaemic
woman,
who
was
on
Departments of Endocrinology and Internal Medicine,
University Hospital Leiden,
Clinical Pharmacology Service, Internal Medicine Department, and Haematology Service,
J. SOTO ALVAREZ J. A. SACRISTAN DEL CASTILLO I. SAMPEDRO GARCIA M. J. ALSAR ORTIZ
Hospital Marqués de Valdecilla, 39008 Santander, Spain
1. Saxon A, Beall GN, Rohr AS, Adelman DC. Immediate hypersensitivity reactions to beta-lactam antibiotics. Ann Intern Med 1987; 107: 204-15. 2. Donowitz GR, Mandell GL. Beta-lactam antibiotics. N Engl J Med 1988; 318: 490-500. 3. Saxon A, Hassner A, Swabb EA, Wheeler B, Adkinson NF Jr. Lack of cross-reactivity between aztreonam, a monobactam antibiotic, and penicillin-allergic subjects. J Infect Dis 1984; 149: 16. 4. Assem ESK. Drug allergy. Current Opinion Immunol 1989; 1: 660-66.
Spironolactone for porphyria cutanea tarda associated hirsutism SIR,-Porphyria cutanea tarda is often associated with hirsutism or hypertrichosis. Neither the cause of this hirsutism nor any relation to androgen metabolism is known. The only treatment for this often disfiguring hirsutism is cosmetic (eg, shaving or depilatory procedures). A 36-year-old woman who has had porphyria cutanea tarda since the age of 27, had had for the previous 8 years progressive hair growth on her face and thighs and she had to shave twice daily. Her hair growth score (Feriman and Gallwey) was 14, normal being below 7. No other signs of virilism were found. Extensive hormone testing revealed no androgen excess or any other endocrine disorder. The androsterone/aetiocholanolone ratio and the excretion of androstanediol glucuronide were normal, indicating that increased 5
