Wong Jason, Sandoval Ashley, Jean Tiffany, Naderi Asal Gharib
Division of Immunology, Irvine Medical Center, University of California, Orange, CA, USA.
SAGE Open Med Case Rep. 2021 Oct 28;9:2050313X211056409. doi: 10.1177/2050313X211056409. eCollection 2021.
We present the unique case of a 33-year-old male referred to our clinic in search of analgesic options who was found to have a delayed hypersensitivity reaction to ibuprofen manifesting as a maculopapular rash and acute urticaria to acetaminophen. Non-steroidal anti-inflammatory drugs are associated with predictable reactions as well as immunoglobulin E-mediated reactions or T-cell mediated reactions. This case highlights the importance of knowledge of the different types of reactions to non-steroidal anti-inflammatory agents as well as the risk of cross reactivity. Delayed reaction to a single non-steroidal agent is rare; urticaria to acetaminophen is very rare. This is the first report we have found in the literature where one individual has a delayed reaction manifesting as rash to ibuprofen as well as urticaria to acetaminophen. We challenged our patient to aspirin which helped identify that his delayed reaction was only to ibuprofen and urticaria only to acetaminophen. The case also highlights the importance of an oral provocation challenge when no contraindications exist which helped us find that he could take celecoxib and avoid narcotics as initial therapy.
我们报告了一例独特的病例，一名33岁男性因寻求止痛方案前来我们诊所就诊，结果发现他对布洛芬有迟发性过敏反应，表现为斑丘疹，对乙酰氨基酚则引发急性荨麻疹。非甾体抗炎药既会引发可预测的反应，也会引发免疫球蛋白E介导的反应或T细胞介导的反应。该病例凸显了了解非甾体抗炎药不同类型反应以及交叉反应风险的重要性。对单一非甾体药物的迟发性反应很罕见；对乙酰氨基酚引发的荨麻疹极为罕见。这是我们在文献中发现的首例报告，即同一个人对布洛芬有表现为皮疹的迟发性反应，对乙酰氨基酚有荨麻疹反应。我们让患者试用阿司匹林，这有助于确定他的迟发性反应仅针对布洛芬，荨麻疹仅由对乙酰氨基酚引发。该病例还凸显了在无禁忌证时进行口服激发试验的重要性，这帮助我们发现他可以服用塞来昔布并避免使用麻醉剂作为初始治疗。
