After accidental re-exposure to metamizole a 50-year-old patient developed severe jaundice within five hours (total bilirubin 43.9 mg/dl) with a rise of GOT to 147, of GPT to 222, of gamma-GT to 380 and of alkaline phosphatase to 497 U/l. The allergic genesis of this reaction was demonstrated in the lymphocyte transformation test which, in the presence of the causative substance and its metabolites, was performed five times during a period of 232 days. The first three tests were positive with stimulation indices up to 2.3. Sensitization to the metabolite 4-aminoantipyrine was demonstrated: this is known to be the first of four metabolites formed within 1-1 1/2 hours and constituting 40% of the four metabolites in the blood.
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