Incidence of bronchoconstriction due to aspirin, azo dyes, non-azo dyes, and preservatives in a population of perennial asthmatics

Weber, Richard W.; Hoffman, Melvin; Raine, Dudley A.; Nelson, Harold S.

doi:10.1016/0091-6749(79)90080-0

Cited by 163 publications

(75 citation statements)

References 20 publications

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“…6 This contrasts with the results of studies using an oral aspirin challenge in which 20 to 34% of asthmatic patients exhibited aspirin-induced asthma. 3,7 The incidence was much higher if patients with a positive history of aspirin-induced asthma were included. 7 It was also found that the response to aspirin challenge may change from one occasion to the other.…”

Section: Discussionmentioning

confidence: 99%

“…3,7 The incidence was much higher if patients with a positive history of aspirin-induced asthma were included. 7 It was also found that the response to aspirin challenge may change from one occasion to the other. 8 The problem of aspirin idiosyncrasy is compounded by the finding that many other substances, including other nonsteroidal antiinflammatory drugs, 9 tar-trazine, 7,9 and sulfinpyrazone, 2 are highly cross reactive in aspirin-sensitive asthmatics during aspirin challenge.…”

Section: Discussionmentioning

confidence: 99%

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A Fatal Case of Aspirin Idiosyncrasy

Al-Balla

1990

Ann Saudi Med

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S Alballa, A Fatal Case of Aspirin Idiosyncrasy. 1990; 10(5): 576-577 Aspirin is probably the most widely prescribed drug in the world and is present in over four hundred proprietary drugs. It is not an absolutely safe drug and should be taken only for appropriate indications.1 Many side effects have been ascribed to aspirin, probably caused by different mechanisms and with variable incidences. The respiratory side effect is considered an idiosyncratic reaction.2 This term refers to a qualitatively abnormal reaction to a drug that is not due to an allergic mechanism.2 Idiosyncratic reactions are serious but underdiagnosed, 3 and their relationship to aspirin intake may be overlooked if proprietary drugs containing aspirin are used. Case ReportA 50-year-old Saudi man was admitted to the hospital following a 5-day history of shortness of breath and wheezing. He had had no history of allergy or atopy, but did describe recurrent episodes of nasal discharge, and bronchial asthma had been diagnosed when he was 33 years old. He was not on treatment at the time of admission.Examination revealed bilateral expiratory rhonchi. He also had a nasal polyp on the right side. He was treated with a salbutamol inhaler and intravenously administered aminophylline and was discharged five days later on oral aminophylline. On the day of discharge, when at home, he took two acetylsalicylic acid tablets (aspirin) for headache. A few minutes later he collapsed and was brought to the hospital in a state of respiratory arrest. He was successfully resuscitated and was discharged with the diagnosis of aspirin idiosyncrasy and aspirin-induced asthma. Both the patient and his family were informed about this idiosyncrasy and he was instructed to avoid any aspirincontaining products.Seven months later, he was seen by his general practitioner for a cold and was given Otrivin (xylometazoline hydrochloride) and Sedergine (330 mg of aspirin, 200 mg of ascorbic acid). Within minutes of taking the first dose he collapsed and was brought to the hospital, where on arrival, he was found to be in cardiopulmonary arrest. He was resuscitated and transferred to the intensive care unit. Unfortunately, he remained comatose and brain death was diagnosed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Fatal Case of Aspirin Idiosyncrasy

Al-Balla

1990

Ann Saudi Med

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“…[112][113][114] Because of both the seriousness of these reactions and the widespread use of tartrazine in foods and over-the-counter and prescription drugs, since 1980 the FDA has required that all products containing tartrazine be labeled so that these substances can be avoided. 115 Patients with the classic aspirin triad reaction (asthma, urticaria, and rhinitis) or anaphylactoid reactions may also develop similar reactions from dyes other than tartrazine, including amaranth, 116 -118 erythrosine, 118 Gastrointestinal intolerance, with abdominal pain, vomiting, and indigestion, has been associated with sunset yellow; in one case, eosinophilia and hives were also present. 123,124 Other dermatologic reactions, including photosensitivity, erythroderma, and desquamation, 125 have been attributed to erythrosine, an iodine-containing dye.…”

Section: Coloring Agentsmentioning

confidence: 99%

“Inactive” Ingredients in Pharmaceutical Products: Update (Subject Review)

1997

Pediatrics

141

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ABSTRACT. Because of an increasing number of reports of adverse reactions associated with pharmaceutical excipients, in 1985 the Committee on Drugs issued a position statement 1 recommending that the Food and Drug Administration mandate labeling of over-thecounter and prescription formulations to include a qualitative list of inactive ingredients. However, labeling of inactive ingredients remains voluntary. Adverse reactions continue to be reported, although some are no longer considered clinically significant, and other new reactions have emerged. The original statement, therefore, has been updated and its information expanded.ABBREVIATIONS. FDA, Food and Drug Administration; MDIs, metered-dose inhalers Pharmaceutical products often contain agents that have a variety of purposes, including improvement of the appearance, bioavailability, stability, and palatability of the product. Excipients (substances added to confer a suitable consistency or form to a drug, such as the vehicle, preservatives, or stabilizers) frequently make up the majority of the mass or volume of oral and parenteral drug products. These pharmaceutical adjuvants are usually considered to be inert and do not add to or affect the intended action of the therapeutically active ingredients.Some 773 chemical agents have been approved by the Food and Drug Administration (FDA) for use as inactive ingredients in drug products.2 Inasmuch as these compounds are classified as "inactive," no regulatory statutes require listing on product labeling. Pharmacopeial guidelines, enforceable under the Food, Drug, and Cosmetic Act, do require labeling of inactive ingredients for topical, ophthalmic, and parenteral preparations; orally administered products are currently exempt. Because of pressure from professional and consumer organizations asking the FDA to require complete disclosure of all ingredients, voluntary labeling was adopted by the two major pharmaceutical industry trade associations. These voluntary guidelines contain an exemption for "trade secret" components and do not require complete disclosure of all fragrance and flavoring ingredients.Current problems encountered with "inactive" ingredients include benzalkonium chloride-induced bronchospasm from antiasthmatic drugs, aspartameinduced headache and seizures, saccharin-induced cross-sensitivity reactions in children with sulfonamide allergy, benzyl alcohol toxicity in neonates receiving high-dose continuous infusion with preserved medications, dye-related cross-reactions in children with aspirin intolerance, lactose-induced diarrhea, and propylene glycol-induced hyperosmolality and lactic acidosis. Although many other excipients have been implicated in causing adverse reactions, these are the most significant in the pediatric population. ANTIASTHMATIC MEDICATIONSIt is readily appreciated that some percentage of asthmatic children will develop a "paradoxical" bronchospasm after they inhale their medication. Because many of these reactions were attributed to sulfite, which had been highly publicized ...

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“…The reported figure of intolerance to ASA and other non-steroidal anti-inflammatory drugs (NSAID) in patients with asthma differs widely, from 1 to 44% (146,152). In an unselected population an incidence of 0.5% has been reported (125).…”

Section: Azo Dyes and Benzoatesmentioning

confidence: 99%

“…(19,137). Weber et al (152) estimated that bronchoconstriction provoked by food dyes and preservatives occurs in about 2 % of all asthmatics.…”

Section: Definitions Prevalence Oe Hypersensitivity Reactionsmentioning

confidence: 99%

Hypersensitivity reactions to food additives

Hannuksela

Haahtela

1987

Allergy

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Only seldom have food additives been shown to cause true allergic (immunologicjil) reactions. Adverse effects due to various pharmacological or other mechanisms are much more common. The individual tolerance may be decreased for one reason or another, and may fluctuate from time to time. Many patients suffering from food additive reactions have atopic constitutions and such clinical symptoms as fiexural dermatitis, rhinitis and asthma. The most important skin symptoms caused by food additives are urticaria, angioneurotic edema, and contact urticaria. Azo dyes, benzoic acid and several other common food additives may aggravate or, more rarely, even cause urticaria. Spices are one of the most common causes of immunological contact urticaria. Non-immunological contact urticaria is produced by numerous spices, benzoic acid, sorbic acid, cinnamic acid, and many essential oOs. Asthma and rhinitis are the main hypersensitivity symptoms in the respiratory tract, and azo dyes, benzoic acid, and sulfitic food additives are the most common causative agents. Systemic and respiratory reactions to food colorants and benzoates have been claimed to occur more frequently in acetylsalicylic acid-(ASA-)sensitive patients than in non-reactors. Hypersensitivity reactions in organs other than the skin and respiratory tract are rare or poorly documented. Psychological factors play an essential role in both food and food additive reactions.

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Incidence of bronchoconstriction due to aspirin, azo dyes, non-azo dyes, and preservatives in a population of perennial asthmatics

Cited by 163 publications

References 20 publications

A Fatal Case of Aspirin Idiosyncrasy

A Fatal Case of Aspirin Idiosyncrasy

“Inactive” Ingredients in Pharmaceutical Products: Update (Subject Review)

Hypersensitivity reactions to food additives

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