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Acetaminophen Cross-Sensitivity Possible in Children Who React to NSAIDs: Presented at EAACI

By Norra MacReady

VIENNA, AUSTRIA -- June 13, 2006 -- Children who are allergic to most nonsteroidal anti-inflammatory drugs (NSAIDs) may also be hypersensitive to acetaminophen, according to a study presented at the 25^th Congress of the European Academy of Allergology and Clinical Immunology (EAACI).

The incidence of cross-reactive hypersensitivity to acetaminophen (paracetamol) among adolescents and adults with NSAID sensitivity is 7%, but its incidence in children is unknown. A better idea of its occurrence in children would be helpful, as these patients pose a significant treatment challenge, according to a study presented in a poster session on June 11^th.

Woei Kang Liew, MBBS, KK Women's and Children's Hospital, Singapore, and colleagues undertook a retrospective case study involving children who presenting to the hospital's pediatric drug allergy clinic between May 2003 and April 2005. The investigators identified 35 children with NSAID hypersensitivity that was confirmed either by a clear history of recurrent reactions to multiple NSAIDs or a positive result to an oral challenge with NSAIDs.

In children with a clinical history of acetaminophen reaction, cross-reactivity with NSAIDs was confirmed. All children also were evaluated for atopy and underwent skin-prick tests.

A total of 19 children (54%) had additional cross-reactive hypersensitivity to acetaminophen. Compared with the other subjects, children with cross-reactive hypersensitivity were more likely to develop hypersensitivity before 6 years of age (42% vs. 25%), and to have a family history of NSAIDs allergy (26% vs. 6%), but these differences were not statistically significant.

The only significant difference was seen in ethnicity: 94% of the children who did not react to acetaminophen were solely of Chinese descent, while this was the case for 63% of the hypersensitive children (P = .047). According to the researchers, this suggests that genetic variations associated with race may play a role in determining the additional hypersensitivity.

Ten children with hypersensitivity to NSAIDs and acetaminophen underwent further oral challenges with cyclooxygenase 2 (COX-2) inhibitors (8 with valdecoxib, 2 with rofecoxib) in an effort to find other antipyretic options. One patient who took valdecoxib developed mild perioral angioedema.

Patients who did not take COX-2 inhibitors used a variety of treatment measures, including traditional Chinese medicine and lower doses of acetaminophen when necessary for fever control.

These findings suggest that clinicians should consider the possibility of cross-reactive hypersensitivity to acetaminophen in children who react to other NSAIDs, the investigators concluded.


[Presentation title: Cross-Reactive NSAID Hypersensitivity With Paracetamol in Children Exists -- a Lack of Conventional Antipyretics. Poster 652]

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