Bailey B, McGuigan M A
Section of Clinical Pharmacology and Toxicology, Hôpital Sainte-Justine, Montreal, Quebec, Canada.
Ann Emerg Med. 1998 Jun;31(6):710-5. doi: 10.1016/s0196-0644(98)70229-x.
To develop management guidelines for the treatment of anaphylactoid reactions to intravenous N-acetylcysteine (NAC) and to assess the safety of restarting the infusion after a reaction.
In phased 1, we used a 6-year retrospective case series of hospitalized patients and a review of the literature to develop the management guidelines for anaphylactoid reactions to intravenous NAC. In phase 2, these guidelines were evaluated prospectively in our poison-control center.
In phase 1, the charts of 11 patients with anaphylactoid reactions (9 cutaneous and 2 systemic) were reviewed. In most cases, no treatment or treatment with diphenhydramine alone or with salbutamol was sufficient to continue or restart NAC infusion safely. On the basis of our findings in those patients and on published experience, we concluded that anaphylactoid reactions to intravenous NAC are dose-related and the antihistamines are useful in controlling and in preventing recurrence of anaphylactoid symptoms. We developed the following guidelines: flushing requires no treatment, urticaria should be treated with diphenhydramine, and NAC infusion should be continued in both cases. Angioedema and respiratory symptoms each require the administration of diphenhydramine and symptomatic therapy. In these cases, NAC infusion should be stopped but, when necessary, can be started 1 hour after the administration of diphenhydramine in the absence of symptoms. In phase 2, 50 patients (31 cutaneous and 19 systemic reactions) were treated prospectively with the use of these guidelines. Recurrence of symptoms occurred in only one case involving a deviation from the guidelines. The NAC infusion was restarted immediately after the administration of diphenhydramine in a patient who sustained a systemic reaction.
Non-life-threatening anaphylactoid reactions to intravenous NAC are treated easily and the infusion may be continued or restarted safely after the administration of diphenhydramine.
制定静脉注射N-乙酰半胱氨酸（NAC）类过敏反应的治疗管理指南，并评估过敏反应后重新开始输注的安全性。
在第1阶段，我们采用了一个为期6年的住院患者回顾性病例系列，并对文献进行了综述，以制定静脉注射NAC类过敏反应的管理指南。在第2阶段，这些指南在我们的毒物控制中心进行了前瞻性评估。
在第1阶段，回顾了11例类过敏反应患者（9例皮肤反应和2例全身反应）的病历。在大多数情况下，不进行治疗或仅用苯海拉明或沙丁胺醇治疗足以安全地继续或重新开始NAC输注。根据我们对这些患者的研究结果以及已发表的经验，我们得出结论，静脉注射NAC的类过敏反应与剂量相关，抗组胺药有助于控制和预防类过敏症状的复发。我们制定了以下指南：潮红无需治疗，荨麻疹应用苯海拉明治疗，两种情况下均应继续输注NAC。血管性水肿和呼吸道症状均需要给予苯海拉明和对症治疗。在这些情况下，应停止输注NAC，但必要时，在无症状的情况下，可在给予苯海拉明1小时后开始输注。在第2阶段，前瞻性地使用这些指南治疗了50例患者（31例皮肤反应和19例全身反应）。仅1例因偏离指南出现症状复发。1例发生全身反应的患者在给予苯海拉明后立即重新开始输注NAC。
静脉注射NAC的非危及生命的类过敏反应易于治疗，在给予苯海拉明后可安全地继续或重新开始输注。
