Behind the scene: Paracetamol hypersensitivity in children

• Published in: Pediatric allergy and immunology Vol. 32; no. 1; pp. 177 - 185
• Main Authors: Sipahi Cimen, Sevgi, Yucel, Esra, Ozceker, Deniz, Suleyman, Ayse, Hizli Demirkale, Zeynep, Sayili, Ugurcan, Guler, Nermin, Ozdemir, Cevdet, Tamay, Zeynep Ulker, Atanaskovic‐Markovic, Marina
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2021
• Subjects: Analgesics; Asthma; Children; Fever; Hypersensitivity; Inflammation; Intolerance; non‐steroidal anti‐inflammatory drugs; oral challenge test; Paracetamol; Skin tests; non-steroidal anti-inflammatory drugs; hypersensitivity; paracetamol; children; oral challenge test
• ISSN: 0905-6157; 1399-3038
• DOI: 10.1111/pai.13330

Background Paracetamol, a non‐steroidal anti‐inflammatory drug, is commonly being used for fever and pain relief worldwide. The aim of this study was to evaluate children with a suspected history of paracetamol hypersensitivity. Methods Sixty patients who were referred to our clinic in between January 2015 and December 2018 with a suspected history of paracetamol hypersensitivity were included. Reactions were classified according to the European Network for Drug Allergy (ENDA)/Global Allergy and Asthma European Network classification and European Academy of Allergy and Clinical Immunology (EAACI)/ENDA Position Paper. Diagnoses were confirmed by skin tests and oral challenge tests (OCTs). In those with verified paracetamol hypersensitivity, an OCT with a strong COX‐1 inhibitor was performed to classify the type of the reaction to refer as either selective or cross‐intolerance hypersensitivity. A subsequent OCT with a selective COX‐2 inhibitor was performed in those cross‐intolerant patients to find out a safe alternative drug. Results Sixty OCTs with paracetamol were performed to patients with a median age of 8.5 years, and hypersensitivity to paracetamol was verified in 8 patients. Four children were classified as selective responders, and 3 were classified as cross‐intolerant after OCT with a COX‐1 inhibitor. Overall, skin test positivity for paracetamol was detected in only one patient, in whom OCT with paracetamol was negative. In all 3 cross‐intolerant patients, a safe alternative non‐steroidal anti‐inflammatory drug was identified after an OCT with a selective COX‐2 inhibitor. Conclusion OCT stands as the gold‐standard procedure in verifying the diagnosis of patients with paracetamol‐induced drug hypersensitivity, as well as, in defining the type of reactions and finding out safe alternative drugs.