Hypersensitivity to Paracetamol in Asian Children with Early Onset of Nonsteroidal Anti-Inflammatory Drug Allergy

Kidon, Mona; Liew, Woei Kang; Chiang, Wen Chin; Lim, Siok Hoon; Goh, Angela; Tang, Julian; Chay, Oh Moh

doi:10.1159/000102614

Cited by 32 publications

(23 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We postulated that this was due to the adolescent's ability to communicate breathing discomfort and co-operate with a physical examination compared to the young child. Compared to the study by Rudders et al [12], our elicitors of adolescent anaphylaxis included a high proportion of shellfish anaphylaxis (13 vs. 5%) and NSAID drug anaphylaxis, reflecting the high incidence of locally published antipyretic drug allergy [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age

Goh¹,

Soh

Loh³

et al. 2018

Int Arch Allergy Immunol

Self Cite

View full text Add to dashboard Cite

Background: The study objective was to compare age-related differences in the cause and clinical presentation of anaphylaxis. Methods: We conducted a prospective study of patients visiting the emergency department for anaphylaxis. Data were collected from 3 emergency departments from 1 April 2014 to 31 December 2015. Patient electronic records with the diagnoses of allergy, angioedema, urticaria, and anaphylaxis (ICD-9 codes 9953, 9951, 7080, 9950, 7089) were screened and cases fulfilling World Allergy Organisation criteria for anaphylaxis were included. Results: A total of 426 cases of anaphylaxis were identified with a median age of 23 years (range 3 months to 88 years and 9 months). The causes of anaphylaxis were food (n = 236, 55%), drugs (n = 85, 20%), idiopathic (n = 64, 15%), and insect bites or stings (n = 28, 7%). The most common food was shellfish (n = 58, 14%) and the most common drugs were non-steroidal anti-inflammatory drugs (n = 26, 6%). There were more cases of food anaphylaxis in children than in adults (72 vs. 42%, p < 0.001) and more cases of drug anaphylaxis in adults than in children (28 vs. 10%, p < 0.001). Compared to patients of other ages, infants and young children had more gastrointestinal symptoms (adjusted odds ratio [aOR] 2.1, 95% CI 1.1-3.9), while schoolchildren and adolescents had more respiratory symptoms (aOR 2.7, 95% CI 1.4-5.2). Adults had more cardiovascular symptoms (aOR 2.9, 95% CI 1.8-4.6) and hypotension (aOR 3.7, 95% CI 2.1-6.8) compared to children. However, 42% of the infants lacked blood pressure measurements. Conclusions: Knowledge of age-related variation in the cause and clinical presentation of anaphylaxis aids in diagnosis and acute management.

show abstract

Section: Discussionmentioning

confidence: 99%

Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age

Goh¹,

Soh

Loh³

et al. 2018

Int Arch Allergy Immunol

Self Cite

View full text Add to dashboard Cite

show abstract

“…In one of the largest published series, there were slightly more cross‐intolerant patients than selective responders, but this was not the case in smaller studies . One important clinical feature is isolated facial angioedema especially localized on lips or eyelids, which seems to be more frequent in cross‐intolerants . In a study from Singapore, including atopic children, facial angioedema developed in all CI patients during OPTs, and in another one, including children younger than 6 years, it was the most common clinical manifestation, with a frequency of 83% .…”

Section: Epidemiology and Clinical Manifestations In Different Phenotmentioning

confidence: 97%

“…One important clinical feature is isolated facial angioedema especially localized on lips or eyelids, which seems to be more frequent in cross‐intolerants . In a study from Singapore, including atopic children, facial angioedema developed in all CI patients during OPTs, and in another one, including children younger than 6 years, it was the most common clinical manifestation, with a frequency of 83% . The incidence of NSAID‐induced facial angioedema was reported to increase with age in an atopic group of children and adolescents, being reported in less than 5% of infants and toddlers, but in up to 20% of adolescents and young adults .…”

Section: Epidemiology and Clinical Manifestations In Different Phenotmentioning

confidence: 99%

“…35,58 In a study from Singapore, including atopic children, facial angioedema developed in all CI patients during OPTs, 58 and in another one, including children younger than 6 years, it was the most common clinical manifestation, with a frequency of 83%. 57 The incidence of NSAID-induced facial angioedema was reported to increase with age in an atopic group of children and adolescents, being reported in less than 5% of infants and toddlers, but in up to 20% of adolescents and young adults. 59 In a study analyzing the causative agents for a history of isolated angioedema, drug provocation tests were positive merely for NSAIDs although hypersensitivity to different antibiotics was also initially suspected based on the reported clinical history.…”

Section: Epidemi Ology and Clinic Al Manife S Tations In D Ifferentmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

Cavkaytar

Toit

Caimmi

2018

Pediatric Allergy Immunology

View full text Add to dashboard Cite

Non-steroidal anti-inflammatory drugs (NSAIDs) are available as over-the-counter drugs, and they are commonly used in children for their antipyretic, analgesic, and anti-inflammatory effects. NSAIDs are among the most frequently reported drugs associated with hypersensitivity reactions and even with anaphylaxis. A complete evaluation of the patients based on reported clinical manifestations, timing of the reaction, the presence of underlying disease, and reactions to other NSAIDs allows clinicians to stratify children with a history of reaction to NSAIDs. Although NSAID-induced hypersensitivity reactions have mainly been investigated in adults, recent studies have aimed to explore their epidemiology in the pediatric population. This review will cover the current understanding of clinical manifestations, the risk factors, and the different phenotypes of NSAID-induced hypersensitivity reactions with a comprehensive overview of the epidemiologic data from past to present and the practical approach to the management of NSAID hypersensitivity in children and adolescents.

show abstract

“…Whilst a recent Epinephrine auto-injectors prescription survey [4] showed that the most common food trigger is peanut allergy in children < 15 years old, the patients were mostly non-Singaporean children. In addition, non-food anaphylaxis cases in children have not been studied locally, but we have previously reported cross-reactive paracetamol and non-steroidal anti-inflammatory drug (NSAID) hypersensitivity amongst local children [5], and some complicated by anaphylaxis [6]. …”

Section: Introductionmentioning

confidence: 99%

Paediatric anaphylaxis in a Singaporean children cohort: changing food allergy triggers over time

Liew

Chiang

Goh

et al. 2013

Asia Pacific Allergy

Self Cite

View full text Add to dashboard Cite

BackgroundWe have noticed changes in paediatric anaphylaxis triggers locally in Singapore.ObjectiveWe aimed to describe the demographic characteristics, clinical features, causative agents and management of children presenting with anaphylaxis.MethodsThis is a retrospective study of Singaporean children presenting with anaphylaxis between January 2005 and December 2009 to a tertiary paediatric hospital.ResultsOne hundred and eight cases of anaphylaxis in 98 children were included. Food was the commonest trigger (63%), followed by drugs (30%), whilst 7% were idiopathic. Peanut was the top food trigger (19%), followed by egg (12%), shellfish (10%) and bird's nest (10%). Ibuprofen was the commonest cause of drug induced anaphylaxis (50%), followed by paracetamol (15%) and other nonsteroidal anti-inflammatory drugs (NSAIDs, 12%). The median age of presentation for all anaphylaxis cases was 7.9 years old (interquartile range 3.6 to 10.8 years), but food triggers occurred significantly earlier compared to drugs (median 4.9 years vs. 10.5 years, p < 0.05). Mucocutaneous (91%) and respiratory features (88%) were the principal presenting symptoms. Drug anaphylaxis was more likely to result in hypotension compared to food anaphylaxis (21.9% vs. 2.7%, Fisher's exact probability < 0.01). There were 4 reported cases (3.6%) of biphasic reaction occurring within 24 h of anaphylaxis.ConclusionFood anaphylaxis patterns have changed over time in our study cohort of Singaporean children. Peanuts allergy, almost absent a decade ago, is currently the top food trigger, whilst seafood and bird's nest continue to be an important cause of food anaphylaxis locally. NSAIDs and paracetamol hypersensitivity are unique causes of drug induced anaphylaxis locally.

show abstract

Hypersensitivity to Paracetamol in Asian Children with Early Onset of Nonsteroidal Anti-Inflammatory Drug Allergy

Cited by 32 publications

References 37 publications

Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age

Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

Paediatric anaphylaxis in a Singaporean children cohort: changing food allergy triggers over time

Contact Info

Product

Resources

About