Introduction Food-drug interactions have been reported to occur for a large variety of drugs. The causes of these interactions are mainly dividedintopharmacodynamicandpharmacokineticprocesses. Amongthelatter,drugmetabolismplaysacrucialroleindrugin- teractions[9].Ametabolicfood-druginteractionoccurswhena certainfoodisabletochangetheactivityofadrug-metabolizing enzyme,orwhenadrugisabletomodifysomemetabolicpath- waysnecessaryforthefoodprocessing[9].Wereportacaseof generalized urticaria diagonised in a young woman undergoing treatmentwithclomipramine,afteringestionofcodfish. Case A 33-year-old woman (weight: 48kg; height 155 cm), without anymedicalhistoryofadversedrugreactionsandwithadequate renalandhepaticfunctionswasadmittedonDecember2004to thePsychiatricUnitoftheªMaterDominiºUniversityHospitalof Catanzaroforboththeinsurgenceofanxietysymptomsandre- currentideasconcerninghome-cleaning. Thepatientwasahousewife,withoutahistoryofallergic,auto- immuneorrheumatologicdiseasesinhersonsorparents.There wasnohistoryofalcoholorotherdrugabuse,andnosignificant pastmedicalorsurgicalevents.Afterpsychiatricevaluation,the diagnosisofobsessive-compulsivedisorder(OCD)wasmadeac- cordingtoDSM-IV-TRandtreatmentwithclomipramine(75mg/ day) plus alprazolam (0.5mg/day) were started. About one monthlater(12thJanuary2005)thepatientwasnewlyevaluat- edforthepersistenceofOCDrelatedsymptoms;therefore,clin- icians increased the clomipramine doses to 100mg/day. After sevendays,asevereandgeneralizedskinrashextendedontrunk andarmswithintenseitchwasobserved. On examination, her blood pressure was 110/70mm Hg, heart rate65beats/min,respiratoryrate18breaths/minandtempera- ture36.2 8C.Noperipherallymphnodeswereobserved.Cardio- vascular,abdominalandrespiratoryrelieveswerenormal.Blood chemicaltestsdidnotrevealanyabnormality.Testsforhepatitis virus(HAV,HBV,HCV),Epstein-Barrvirus(EBV),HIV,cytomega- lovirus,andautoimmuneserologicalmanifestations(antimicro- somalantibody,antismoothmuscleantibodies,liver-kidneymi- crosomal antibodies, thyroid peroxidase antibodies, and anti- double-strandedDNA)werenegative. Local examination of skin rash revealed papular eruption asso- ciatedwithitchingandanincreaseinlocalskintemperaturein most of body regions, especially on the trunk and all over the arms,butwithoutregionalpositivelymphnodes. On20thJanuary2005,asteroidbasedpharmacologicaltherapy wasstartedwithoutanysignificantimprovementofsymptoms. Then,on24thJanuary2005,anewanamnesisexcludedarecent history of allergic manifestations, related to drugs, herbal sup- plements,orcontactswithchemicalagents,butitrevealedthat on the day before the development of skin rash the patient ate codfish.Thepatientassessedthatinthepastthesamefoodhas alwaysbeenwelltolerated.Atthebeginning,consideringthein- surgenceofskinrashasawell-knowndrug-ownadverseevent, clomipramine was gradually dismissed and changed to paroxe- tine(30mg/day).Aboutfewdaysfollowingthebeginningofpar- oxetine(2ndFebruary2005)anewclinicalevaluationshoweda completedecreaseinskinmanifestationsbutalsoalessereffica- cy in the control of OCD symptoms. In agreement with the pa- tient, we decided to further investigate the possible drug-food Generalised Urticaria in a Young Woman treated with Clomipramine and after Ingestion of Codfish A Case Report L. Gallelli 1, 2 , S. De Fazio 1, 2 , E. Corace 3 , G. De Sarro 1 , C. Segura Garcia 3 , P. De Fazio 3 Affiliation: 1 ClinicalPharmacologyandPharmacovigilanceUnit Departmentof ExperimentalandClinicalMedicine FacultyofMedicineandSurgery University MagnaGraeciaofCatanzaro MaterDominiUniversityHospital Catanzaro Ita- ly´ 2 Sharetheauthorship´ 3 PsychiatryUnit DepartmentofExperimentaland ClinicalMedicine FacultyofMedicineandSurgery UniversityMagnaGraeciaof Catanzaro MaterDominiUniversityHospital Catanzaro Italy Correspondence: LucaGallelli,M.D.,Ph.D.´ClinicalPharmacologyandPharma- covigilanceUnit´MaterDominiUniversityHospital´DepartmentofExperimen- talandClinicalMedicine´FacultyofMedicineandSurgery´UniversityMagna GraeciaofCatanzaro´ViaT.Campanella,115´88100Catanzaro´Italy´Phone: +390961712322´Fax:+390961774424´E-mail:luca_gallelli@hotmail.com Received 7.11.2005´ Revised 8.3.2006´ Accepted 13.3.2006 Bibliography: Pharmacopsychiatry2006;39:1±3GeorgThiemeVerlagKG Stuttgart´NewYork´DOI n ´ISSN0176-3679 Background: Wereportacaseofgeneralizeddermatitisanditch induced by a possible drug-food interaction in a young woman who was consuming clomipramine for Obsessive Compulsive Disorder(OCD).A33-year-oldwomanaffectedbyanxietysymp- toms presented to our observation for a clinical evaluation. Methods: After psychiatric evaluation, the diagnosis of OCD was performed according to DSM-IV-TR and a pharmacological treatmentwithclomipramine(75±100mg/day)plusalprazolam (0.5mg/day) was started. Results: About one month later, the patient developed a severe generalized urticaria with intense itch.Anewanamnesisrevealedthatonthedaybeforethedevel- opment of the skin rash, no other drug was consumed and the patienthadeatencodfish;clomipraminewasthengraduallydis- continuedandchangedintoparoxetine(30mg/day).Atthemo- mentthepatientdoesnotshowanyOCDrelatedsymptomand any adverse event to paroxetine treatment has been recorded. Conclusion: Wepostulateapossibleinteractionbetweenclomi- pramine and codfish ingestion. Allergic potential of clomipra- mine was investigated, while clomipramine de-challenge in- duced a decrease of the skin rash, the drug re-challenge per- formed one month later did not induce any adverse event. In contrast,whenthecombinedre-challengeofcodfishandclomi- praminewasperformedurticariawasnewlyobserved.TheNar- anjo Probability Scale Score suggested a probable causal rela- tionship between drug-food interaction and the skin rash. In conclusion, we suggest evaluating also the complete risk of drug-foodinteractionoccurringonclomipraminetreatment. Pharmaco Letter 4068/2005/458, 13.4.06/Druckerei Sommer Letter 1