Anaphylactic Reaction due to Paracetamol, A Case Study

Main Category: Public Health
Article Date: 06 Jun 2004 - 21:00 PDT


A 58-year old woman had anaphylactic reaction two hours after oral administration of paracetamol. She was treated conservatively and responded favourably. This incident is being reported as anaphylaxis to paracetamol which is rare. Whenever there is history of allergy to other non-narcotic analgesic drugs, paracetamol sensitivity should be tested under medical supervision.



Paracetamol is widely used for its antipyretic and analgesic effects and is freely available as over-the-counter (OTC) drug. Among the non-narcotic analgesic drugs, paracetamol is found to be very safe1. But still severe reactions like anaphylaxis following administration of paracetamol was reported2. Here a case of an anaphylactic reaction to oral administration with 500 mg of paracetamol is reported due its rare incidence.

CASE REPORT

A 58-year-old female was admitted with cough of three months duration. There were associated headache and nasal discharge. She had history of urticaria and multiple drug allergies including ampicillin, ibuprofen, diclofenac.

Previously any drug given to her for pain resulted in skin rashes, pruritus and facial oedema. She was administered oral paracetamol (500 mg) on admission at 10-30 AM. At about 12-30 PM, the patient developed severe itching and rash all over the body along with facial oedema and swelling of lips. This was quickly followed by change in voice and tachypnoea.

Examination - Her blood pressure was 124/80 mm Hg on admission. Respiratory system examination was unremarkable except for tenderness over frontal sinuses. After intake of paracetamol, she was found to have hypotension and altered sensorium. Diffuse rhonchi was heard on auscultation. The diagnosis of anaphylactic shock was made as the clinical features were suggestive of anaphylaxis3.

Investigations - Her blood counts revealed haemoglobin of 12.7 g/dl, total leucocyte count of 9,100/mm3 with 3% eosinophils. Chest x-ray and electrocardiogram were normal. X-ray paranasal sinuses was suggestive of frontal sinusitis.

Treatment - Injection adrenaline 0.5 ml (1:1000) was given intramuscularly and rapid infusion of normal saline along with high flow nasal oxygen was started. Intravenous dopamine in normal saline was also started as blood pressure was not recordable. Nebulised salbutamol was given every 15 minutes till bronchospasm was controlled. Hydrocortisone (200 mg) was given intravenously and patient was kept under close monitoring. Injection adrenaline was repeated after 20 minutes and infusion of normal saline and dopamine continued till systolic blood pressure had risen to above 90 mm Hg. Patient recovered fully within two hours.

To continue reading click here.......Journal of the Indian Medical Association

• Additional
• References
• Citations