July 27, 2017
Flushing Minimize

Flushing

Flushing is a well recognised phenomenon of transient cutaneous vasodilatation due to emotional, autonomic or endocrine influences or pharmacological factors.

Menopausal flushing may develop in the male after orchidectomy or GnRH therapy for prostate cancer.

Histamine flushes may be due to large quantities of histamine in some alcoholic beverages, to the pharmacological effect of some drugs, or mast cell disease. Flushing often occurs in anaphylactic reactions but it is invariably associated with other systemic symptoms eg urticaria, upper airway obstruction etc.

Alcohol may induce flushing even without chlorpropamide, metronidazole or disulfuran.

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Idiopathic flushing

Flushing is more likely to be idiopathic in young female patients than due to carcinoid. Features characteristic of idiopathic flushing included palpitations, syncope and hypotensive episodes whereas carcinoid was more likely to cause wheezing and abdominal pain. Diarrhoea occurs in both conditions.

Recurrent unexplained flushing

This disorder has been described in 10 patients with recurrent unexplained flushing. Patients reported attacks of flushing lasting 15 minutes to 2 days and associated with such symptoms as anxiety, chest tightness, parasthesia, slurred speech, weakness, and pruritus. Abdominal pain was a constant feature, often associated with cramping and an increase in stool frequency. Attacks witnessed by physicians consisted of an exaggerated blush response of the face and upper part of the chest, and were sometimes associated with tachycardia, mild hypertension, and tachypnea. Urticaria, angioedema, wheezing, and hypotension were not observed. This condition is characterised by repeatedly negative investigations performed over many years.

Drugs recognised to cause flushing

anti-depressants

L-DOPA

amyl nitrite

metronidazole (with alcohol)

beta-blockers

nicotinic acid

Calcium channel blockers

nitrates

cephalosporins (with alcohol)

oxybutynin

chlorpropamide (with alcohol)

pilocarpine

danazol

tretinoin

desmopressin

TRH

histamine

 

References

  • Aldrich LB, Moattari AR, Vinik AI. Distinguishing features of idiopathic flushing and carcinoid syndrome. Arch Intern Med 1988;148:2614-2618.
  • Davies DM (ed). Textbook of adverse drug reactions. Oxford: Oxford University Press. 4th edit 1991.
  • Friedman BS, Germano P, Miletti J, Metcalfe DD. A clinicopathologic study of ten patients with recurrent unexplained flushing. J Allergy Clin Immunol 1994;93:53-58.
  • Gelman Gr, Rumack BH (eds). Drugdex (R) Information System. Denver: Micromedex Inc (edition expires 30 June 1997).
  • Winbury SL, Lieberman PL. Anaphylaxis. Immunol Allergy Clin NA 1995;15:447-475.
  

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