Idiosyncrasy to Pyrazolone Drugs

Abstract

Studies carried out in 68 patients with idiosyncratic reactions to noramidopyrine and/or aminophenazone led to distinction of two different groups. In the first group: 1) noramidopyrine, aminophenazone, phenylbutazone and sulfinpyrazone as well as several other inhibitors of cyclooxygenase, including aspirin, precipitated bronchoconstriction; 2) skin tests with pyrazolone drugs were virtually negative; 3) all patients had chronic asthma. In the second group: 1) noramidopyrine and aminophenazone induced anaphylactic shock and/or urticaria; 2) skin tests with these drugs were highly positive; 3) phenylbutazone, sulfinpyrazone and several other cyclooxygenase inhibitors, including aspirin, could be taken with impunity; 4) chronic bronchial asthma was present in only one-fourth of the patients. We suggest that the pathogenic mechanisms responsible for the idiosyncratic reactions involve inhibition of cyclooxygenase in the first group, and allergic reactions in the second group. Distinction of these two groups is of clinical importance since in individual patients it gives insight into the safe administration of pyrazolone and aspirin-like drugs.

The atopy trait in hypersensitivity to nonsteroidal anti‐inflammatory drugs

“…An immunologic background to the selective hypersensitivity to pyrazolone drugs is suggested by positive skin tests with noramidopyrine and/or aminophenazone, and by the lack of any relation between the effects of these drugs on prostaglandin biosynthesis and their clinical effects in hypersensitive patients (2,3 ) . Noramidopyrine is a weak inhibitor of prostaglandin biosynthesis, while aminophenazone stimulates the generation of prostaglandins (2).…”

“…Asthma attacks and other symptoms of intolerance appear to result from inhibition of cyclooxygenase (COX), leading to an imbalance of prostanoids in the respiratory tract (2,3), and probable overproduction of leukotrienes (9). Most patients have chronic asthma and/or chronic rhinosinusitis with nasal polyps (4 j.…”

“…In the second group, the mechanism responsible for the adverse reactions seems to have an immunologic, IgE-mediated background (3,5 ) . In these patients, anaphylactic shock, urticaria, and angioedema are precipitated only by two structurally related pyrazolone drugs: aminophenazone and nor-amidopyrine (2, 3).…”

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

“…The clinical pattern of symptoms as well as the timing of the reaction strongly suggests immunological IgEmediated type of reaction. Positive skin tests to a culprit drug or drug-specific serum IgE may be found in a significant proportion of patients with noncross-reactive type of hypersensitivity to pyrazolones (64). However, only anecdotal reports were able to detect presence of specific IgE in other single NSAIDs reactors (65).…”

Analgesics, allergy and asthma.

“…Untoward reactions to pyrazolone analgesics can be very dangerous. Of 28 such patients 22 developed anaphylactic shock after taking a single dose of aminophenazone or noramidopyrine, whereas in the remaining six, urticaria/angioedema occurred (Czerniawska- Mysik & Szczeklik, 1980). Scarification and/or intracutaneous tests carried out with aminophenazone or noramidopyrine 2-12 months after the acute reaction were positive in all patients.…”