Research Article| Volume 8, ISSUE 1, P59-61, January 1990

Topically induced diphenhydramine toxicity

      This paper is only available as a PDF. To read, Please Download here.


      We report the case of a Math Eq-year-old child who manifested acute anticholinergic toxicity after the applications of a topical calamine-antihistamine lotion. This mechanism of diphenhydramine toxicity is uncommon, with only a few other case reports noted in the literature. This case is also intriguing in that this child had an underlying varicella illness with fever that tended to obscure the picture. This report describes the characteristic history and physical examination pertinent to anticholinergic toxicity, varicella complication considerations, and case management.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Loew E.R.
        • Kaiser M.E.
        • Moore V.
        Synthetic benzhydryl alkamine ethers effective in preventing fatal experimental asthma in guinea pigs exposed to atomized histamine.
        J Pharmacol Exp Ther. 1945; : 120
        • Wyngaarden J.B.
        • Seevers M.H.
        The toxic effects of antihistaminic drugs.
        JAMA. 1951; 145: 277-282
        • Koppel C.
        • Ibe K.
        • Tenczer J.
        Clinical symptomatology of diphenhydramine overdose: an evaluation of 136 cases in 1982 to 1985.
        Clin Toxicol. 1987; 25: 53-70
        • Sankey R.J.
        • Nunn A.J.
        • Sills J.A.
        Visual hallucinations in children receiving decongestants.
        Br Med J. 1984; 228: 139
      1. 2nd ed. Practice of pediatrics. 24. Harper & Row, Philadelphia1987: 41-42
        • Appelbaum E.
        • Rachelson M.H.
        • Dolgopol V.B.
        Varicella encephalitis.
        AM J Med. 1953; 15: 223-230
        • Filloux F.
        Toxic encephalopathy caused by topically applied diphenhydramine.
        J Pediatr. 1986; 108: 1018-1020
        • Tomlinson G.
        • Helfaer M.
        • Wiedermann B.L.
        Diphenhydramine toxicity mimicking varicella encephalitis.
        Pediatr Infect Dis. 1987; 6: 220-221
        • Patrenella R.
        Diphenhydramine toxicity due to topical application of Caladryl.
        Clin Pediatr. 1986; 25: 163
        • Woodward G.A.
        • Baldassano R.N.
        Topical diphenhydramine toxicity in a five year old with varicella.
        Pediatr Emer Care. 1988; 4: 18-20
        • Shawn D.H.
        • McGuigan M.A.
        Poisoning from dermal absorption of promethazine.
        Can Med Assoc J. 1984; 130: 146-151
        • Goldfrank L.R.
        in: Goldfrank L.R. Flomenbaum N.E. Lewin N.A. Toxicologic emergencies. Appleton-Century-Crofts, East Norwalk, Connecticut1986: 351-363