Schwarz N, Ham Pong A
Ottawa Civic Hospital, Canada.
Ann Allergy Asthma Immunol. 1996 Dec;77(6):473-4. doi: 10.1016/s1081-1206(10)63352-2.
Aspirin idiosyncrasy can present with bronchospasm or cutaneous reactions, but combined pulmonary and cutaneous reactions are rare. High-dose acetaminophen has been reported to provoke bronchospasm in aspirin-sensitive asthmatic patients.
We report an asthmatic adolescent female who had anaphylaxis with 650 mg acetaminophen after tolerating 325-mg doses for years. She subsequently in sequence had urticaria with aspirin and ibuprofen, and anaphylaxis with sodium salicylate. She was then challenged with acetaminophen, 325 mg orally.
Approximately 30 minutes after acetaminophen challenge, she developed rhinoconjunctivitis, urticaria, pruritus, cough, and bronchospasm reversed with antihistamines and bronchodilators.
Aspirin sensitivity has not frequently been described in younger age groups. This patient also had several unusual features in that she presented first with sensitivity to acetaminophen that was then followed by aspirin sensitivity. She had urticaria with both aspirin and sodium salicylate; she had combined pulmonary and cutaneous reactions to both acetaminophen and aspirin, which are rarely described; and she had anaphylaxis with low-dose acetaminophen.
阿司匹林特异反应可表现为支气管痉挛或皮肤反应，但肺部和皮肤联合反应罕见。据报道，高剂量对乙酰氨基酚可诱发阿司匹林敏感的哮喘患者出现支气管痉挛。
我们报告一名哮喘青少年女性，多年来耐受325毫克剂量的对乙酰氨基酚，却在服用650毫克后发生过敏反应。随后，她依次出现服用阿司匹林和布洛芬后的荨麻疹，以及服用水杨酸钠后的过敏反应。然后，对她进行口服325毫克对乙酰氨基酚的激发试验。
对乙酰氨基酚激发试验后约30分钟，她出现鼻结膜炎、荨麻疹、瘙痒、咳嗽，使用抗组胺药和支气管扩张剂后支气管痉挛得到缓解。
阿司匹林敏感性在较年轻年龄组中并不常见。该患者还有几个不寻常的特征，即她首先表现出对对乙酰氨基酚敏感，随后是阿司匹林敏感。她服用阿司匹林和水杨酸钠后均出现荨麻疹；她对乙酰氨基酚和阿司匹林均出现肺部和皮肤联合反应，这种情况很少见；并且她服用低剂量对乙酰氨基酚后发生过敏反应。
