Paracetamol (acetaminophen) hypersensitivity

Paramo, Berta Juliade; Gancedo, Santiago Quirce; Cuevas, M.; Camo, Ignacio Perez; Martín, J.A.; Cosmes, Eloy Losada

doi:10.1016/s1081-1206(10)62580-x

Cited by 71 publications

(64 citation statements)

References 7 publications

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“…Analysis of the other drugs for which skin tests were performed (diclofenac and paracetamol) did not reveal a positive response, although some studies have shown that this can occur [28]. Therefore, drug involvement was established by drug provocation testing as reported elsewhere [8], in patients with only 1 reported episode or negative skin test result.…”

Section: Discussionmentioning

confidence: 99%

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Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Pérez-Alzate

Cornejo-García

Pérez‐Sánchez

et al. 2017

J Investig Allergol Clin Immunol

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Background: Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors. Methods: Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration. Results: From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients. Conclusions: Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.

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Section: Discussionmentioning

confidence: 99%

“…The general diagnostic algorithm is outlined in the Figure. Skin testing was performed with those drugs for which positive immediate results have already been reported, namely, metamizole [27], paracetamol [28], and diclofenac [29]. Concentrations were used as previously reported [29][30][31].…”

Section: Allergology Workupmentioning

confidence: 99%

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Pérez-Alzate

Cornejo-García

Pérez‐Sánchez

et al. 2017

J Investig Allergol Clin Immunol

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“…Other symptoms, such as generalized pruritus, rhinitis, and bronchospasm, may also be present in some patients. In single-drug reactors to acetaminophen, generalized urticaria and angioedema are most prevalent, although anaphylactic shock has also been described (69).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…These observations suggest that reliable diagnosis skin testing should be performed as soon as possible after clearance of the reaction and interruption of the antiallergic treatment. A few studies only, including small number of patients, assessed the diagnostic value of skin tests in patients with suspected immediate-type allergy to paracetamol or other NSAIDs (69,72).…”

Section: Skin Testingmentioning

confidence: 99%

Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA# and GA2LEN/HANNA*

Kowalski

Makowska

Blanca³

et al. 2011

Allergy

381

356

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Following the first description of hypersensitivity reaction to aspirin (ASA) by Hirschberg in 1902, several types of hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) have been described. The NSAIDs-induced hypersensitivity reactions involve different mechanisms and present a wide range of clinical manifestations from anaphylaxis AbstractNonsteroidal anti-inflammatory drugs (NSAIDs) are responsible for 21-25% of reported adverse drug events which include immunological and nonimmunological hypersensitivity reactions. This study presents up-to-date information on pathomechanisms, clinical spectrum, diagnostic tools and management of hypersensitivity reactions to NSAIDs. Clinically, NSAID hypersensitivity is particularly manifested by bronchial asthma, rhinosinusitis, anaphylaxis or urticaria and variety of late cutaneous and organ-specific reactions. Diagnosis of hypersensitivity to a NSAID includes understanding of the underlying mechanism and is necessary for prevention and management. A stepwise approach to the diagnosis of hypersensitivity to NSAIDs is proposed, including clinical history, in vitro testing and/ or provocation test with a culprit or alternative drug depending on the type of the reaction. The diagnostic process should result in providing the patient with written information both on forbidden and on alternative drugs.

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“…Relationship between asthma epidemic and per-capita sales of acetaminophen across countries [68] 7. Plausible mechanism [47,63,[69][70][71][72] 7 Contrary to commonsense intuition, ''safety signal'' does not refer to indicators of safety, but rather the contrary, i.e. signals suggesting possible risks associated with the drug.…”

Section: Case Study: the Paracetamol Enigma In Asthmamentioning

confidence: 99%

Causal Assessment of Pharmaceutical Treatments: Why Standards of Evidence Should not be the Same for Benefits and Harms?

Osimani

Mignini

2014

Drug Saf

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It is increasingly acknowledged both among epidemiologists and regulators that the assessment of pharmaceutical harm requires specific methodological approaches that cannot simply duplicate those developed for testing efficacy. However, this intuition lacks sound epistemic bases and delivers ad hoc advice. This paper explains why the same methods of scientific inference do not fare equally well for efficacy and safety assessment by tracing them back to their epistemic foundations. To illustrate this, Cartwright's distinction into clinching and vouching methods is adopted and a series of reasons is provided for preferring the latter to the former: (1) the need to take into account all available knowledge and integrate it with incoming data; (2) the awareness that a latent unknown risk may always change the safety profile of a given drug (precautionary principle); (3) cumulative learning over time; (4) requirement of probabilistic causal assessment to allow decision under uncertainty; (5) impartiality; and (6) limited and local information provided by randomised controlled trials. Subsequently, the clinchers/vouchers distinction is applied to a case study concerning the debated causal association between paracetamol and asthma. This study illustrates the tension between implicit epistemologies adopted in evaluating evidence and causality; furthermore, it also shows that discounting causal evidence may be a result of unacknowledged low priors or lack of valid alternative options. We conclude with a presentation of the changing landscape in pharmacology and the trend towards an increased use of Bayesian tools for assessment of harms. Key PointsCausal assessment and scientific inference in pharmacology: inductivist approaches fare better than hypothetico-deductive ones when dealing with harms

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Paracetamol (acetaminophen) hypersensitivity

Cited by 71 publications

References 7 publications

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA# and GA2LEN/HANNA*

Causal Assessment of Pharmaceutical Treatments: Why Standards of Evidence Should not be the Same for Benefits and Harms?

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