Piroxicam‐induced fixed drug eruption: Cross‐reactivity with meloxicam

Background Non‐steroidal anti‐inflammatory drugs constitute a main cause of fixed drug eruption (FDE). A few cases of piroxicam‐induced FDE have been reported; however, the cross‐reactivity among oxicams has rarely been evaluated. Objectives To describe a series of patients with piroxicam‐induced FDE, mostly confirmed by a positive patch test reaction, in whom cross‐reactivity to meloxicam was assessed. Methods We included all cases of piroxicam‐induced FDE diagnosed in the department of pharmacovigilance of Monastir. Patch tests for piroxicam and meloxicam were performed in the involved skin according to the European Network on Drug Allergy recommendations. Oral provocation tests (OPTs) were performed for patients with negative skin test results. Results Seven patients were included in this study. FDE was multiple for five patients and solitary for two. Bullous eruption was noticed in two cases. Lesional patch tests for piroxicam gave positive results in six patients. To assess cross‐reactivity with meloxicam, this was patch tested. The test gave a positive result in only one patient. OPTs with meloxicam gave positive results in two patients with negative patch test results. Conclusion Meloxicam is not a safe alternative for the treatment of piroxicam‐induced FDE, and OPTs can be used to confirm tolerance before this drug is prescribed as a safer alternative.