Behind the scene: Paracetamol hypersensitivity in children

Abstract

Background: Paracetamol, a non-steroidal anti-inflammatory drug, is commonly being used for fever and pain relief worldwide. The aim of this study was to evaluate children with a suspected history of paracetamol hypersensitivity. Methods: Sixty patients who were referred to our clinic in between January 2015 and December 2018 with a suspected history of paracetamol hypersensitivity were included. Reactions were classified according to the European Network for Drug Allergy (ENDA)/Global Allergy and Asthma European Network classification and European Academy of Allergy and Clinical Immunology (EAACI)/ENDA Position Paper. Diagnoses were confirmed by skin tests and oral challenge tests (OCTs). In those with verified paracetamol hypersensitivity, an OCT with a strong COX-1 inhibitor was performed to classify the type of the reaction to refer as either selective or cross-intolerance hypersensitivity. A subsequent OCT with a selective COX-2 inhibitor was performed in those cross-intolerant patients to find out a safe alternative drug. Results: Sixty OCTs with paracetamol were performed to patients with a median age of 8.5 years, and hypersensitivity to paracetamol was verified in 8 patients. Four children were classified as selective responders, and 3 were classified as cross-intolerant after OCT with a COX-1 inhibitor. Overall, skin test positivity for paracetamol was detected in only one patient, in whom OCT with paracetamol was negative. In all 3 cross-intolerant patients, a safe alternative non-steroidal anti-inflammatory drug was identified after an OCT with a selective COX-2 inhibitor. Conclusion: OCT stands as the gold-standard procedure in verifying the diagnosis of patients with paracetamol-induced drug hypersensitivity, as well as, in defining the type of reactions and finding out safe alternative drugs.

Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: does age matter?

“…In patients with a positive history of paracetamol-induced hypersensitivity reactions, we performed skin tests that were negative. This is in accordance with the studies published by Sipahi Cimen et al who reported only one positive skin test to paracetamol, but the patient tolerated the OPT with paracetamol [16]. The negative skin tests to paracetamol suggest that the mechanisms that underlie acetaminophen hypersensitivity are not IgE-mediated.…”

NSAID Hypersensitivity in the Pediatric Population: Classification and Diagnostic Strategies

“…The rate of NSAID-H, as confirmed with oral provocation tests (OPT), was measured between 4% and 68% in various patient groups with histories of suspected reactions (Table 2). 25,27,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Considering the general pediatric population, the rate of actual ASA-hypersensitivity (ASA-H) in 1632 control subjects was detected as 0.55% according to the OPT performed independent of suspected ASA-H history. 45 However, in a very recent study in which OPT with ASA was performed Alves, 2017 35 119, NSAID-induced 5-14 y NSAID-H NA OPT w culprit and alternative drug 7.6% Arikoglu, 2017 36 106, NSAID-induced if there was a positive clinical history, only one participant had undergone OPT, and no ASA-H was detected in 2000 control subjects (Table 2).…”

“…25,31,38 The rate of OPT-proven paracetamol hypersensitivity was 13% in children and adolescents with a suspected reaction in their history. 42 In a recent meta-analysis, the prevalence of OPTproven paracetamol hypersensitivity was reported as 10.1%, with a 95% confidence interval of 4.5 to 15.5%. 65 NSAID-H tends to persist for years.…”

Clarithromycin hypersensitivity in children: Is there a link with β‐lactam hypersensitivity?

“…17 It is known that drug allergy may be generally overestimated in children and a suspected history of drug allergy needs to be confirmed by detailed allergy work-up. 18 Our results showed that 94.4%…”

“…It is known that drug allergy may be generally overestimated in children and a suspected history of drug allergy needs to be confirmed by detailed allergy work‐up 18 . Our results showed that 94.4% of study patients with a suspected history of CLR‐HRs could in fact tolerate this antibiotic.…”