The accuracy of the diagnosis of suspected paracetamol (acetaminophen) hypersensitivity: results of a single‐blinded trial

Kvedarienė, Violeta; Bencherioua, A M; Messaad, D.; Godard, P.; Bousquet, Jean; Demoly, Pascal

doi:10.1046/j.1365-2222.2002.01476.x

Cited by 47 publications

(48 citation statements)

References 12 publications

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“…In previous reports, skin tests to paracetamol have usually been found to be negative [18,20,24,25]. A few single cases of a positive immediate response to skin tests and detectable specific IgE have been described [16,26] .…”

Section: Discussionmentioning

confidence: 99%

“…Hypersensitivity reactions to paracetamol include rhinoconjunctivitis, urticaria/angio-oedema, Stevens-Johnson syndrome, fixed drug eruption and anaphylaxis [8,10,15,16,17,18]. There are only a few publications addressing the mechanisms underlying such reactions (3 series and a few case reports [7,8,9,15,18,19,20]) .…”

Section: Introductionmentioning

confidence: 99%

“…There are only a few publications addressing the mechanisms underlying such reactions (3 series and a few case reports [7,8,9,15,18,19,20]) . We report a series of 32 patients with suspected paracetamol hypersensitivity, investigate the possible mechanisms and co-existing non-steroidal anti-inflammatory drug (NSAID) tolerance and suggest an approach to diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Paracetamol Hypersensitivity: Clinical Features, Mechanism and Role of Specific IgE

Rutkowski

Nasser

Ewan

2012

Int Arch Allergy Immunol

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Background: Paracetamol is a common antipyretic/analgesic and a component of many prescription and over- the- counter preparations. Hypersensitivity reactions to paracetamol appear to be increasing, but there are few prevalence data. The mechanism is poorly understood. We identified the clinical features of 32 patients with suspected paracetamol allergy, investigated the underlying mechanism and examined co-existing non-steroidal anti-inflammatory drug (NSAID) tolerance. Methods: Aclinical history was taken and skin tests and an oral challenge were performed in 32 patients with suspected paracetamol allergy. Results: Patients presented with a combination of urticaria, angio-oedema (face, hands), erythema (cutaneous features in 94%), dyspnoea (including laryngeal oedema), rhinoconjunctivitis, cough, abdominal pain and anaphylaxis. Two patients had a positive skin prick test (SPT) and unequivocal history of acute urticaria/facial angio-oedema/conjunctivitis/cough after paracetamol with no other triggers. One patient had a positive intradermal test. Oral challenge was positive in 15 of 31 patients (including self-challenge in 4), triggering (a combination of) rhinitis, conjunctivitis, pruritus, erythema, urticaria, angio-oedema, dyspnoea and abdominal pain. Sensitivity was evident in 1 patient on the basis of the patient’s history. Overall, paracetamol hypersensitivity was confirmed in 16 of the 32 patients (50%). Twelve of the 16 paracetamol-allergic patients (75%)tolerated NSAIDs (negative challenge in 6, negative history in 6). Four of these 16 patients (25%) were intolerant of NSAIDs (positive challenge in 1, self-challenge in 3). Conclusions: In past reports on paracetamol hypersensitivity, only single cases of a positive SPT and detectable specific IgE have been described. Our data confirm that specific IgE may be a mechanism underlying paracetamol hypersensitivity, as in this series 18.8% of the patients had specific IgE. In 81.2% of patients, negative skin tests did not exclude paracetamol hypersensitivity, suggesting that it may be mediated by leukotrienes. However, three quarters of our patients tolerated NSAIDs, implicating an alternative mechanism. In patients with suspected paracetamol allergy, skin tests should be performed in addition to clinical history and oral challenge.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Paracetamol Hypersensitivity: Clinical Features, Mechanism and Role of Specific IgE

Rutkowski

Nasser

Ewan

2012

Int Arch Allergy Immunol

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“…1 In the literature there are descriptions of systemic reactions, including vasculitis, hepatitis with glomerulonephritis, toxic epidermal necrolysis and Stevens-Johnson syndrome. 1,5 The risk of developing SJS or TEN after taking paracetamol is depending on geographic region. In France, on the basis of the cases described in the literature, there were no such cases.…”

Section: Discussionmentioning

confidence: 99%

Stevens-Johnson syndrome in a patient with rheumatoid arthritis during long-term etanercept therapy

Owczarczyk‐Saczonek¹,

Zdanowska²,

Znajewska-Pander³

et al. 2016

J Dermatol Case Rep

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Background: Etanercept and other anti-TNF-alpha agents have been indicated as a therapeutic option in severe drug reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Etanercept has been shown to quickly reduce the detachment of the epidermis and shorten healing time. Cases of etanercept-induced severe adverse drug reactions were also described. Main observations:A 27-year-old woman with a 4-year history of etanercept and sulfasalazine treatment for rheumatoid arthritis was admitted with StevensJohnson syndrome. The patient received one dose of an OTC drug containing acetaminophen, phenylephrine and pheniramine two days prior to developing fist mucocutaneous symptoms. The most probable causative agent was paracetamol. Throughout the successful routine therapy of Stevens-Johnson syndrome etanercept therapy was continued. Sulfosalazin administration was stopped and administered again after recovery with no recurrence of the skin and mucosal symptoms. Conclusions:This case indicates that there is no justification for discontinuation of long-term anti-TNF-alpha treatment in patients who develop StevensJohnson syndrome / toxic epidermal necrolysis.

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“…The incidence of cutaneous adverse reactions reported with standard dosages is quite rare. 1 Several cases of urticaria, fixed drug eruptions, maculopapular eruptions etc. have been reported.…”

Section: Introductionmentioning

confidence: 99%

Toxic epidermal necrolysis induced by acetaminophen: a case report

Gupta

Mittal

Sharma

2013

Int J Basic Clin Pharmacol

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The accuracy of the diagnosis of suspected paracetamol (acetaminophen) hypersensitivity: results of a single‐blinded trial

Cited by 47 publications

References 12 publications

Paracetamol Hypersensitivity: Clinical Features, Mechanism and Role of Specific IgE

Paracetamol Hypersensitivity: Clinical Features, Mechanism and Role of Specific IgE

Stevens-Johnson syndrome in a patient with rheumatoid arthritis during long-term etanercept therapy

Toxic epidermal necrolysis induced by acetaminophen: a case report

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