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Acetaminophen allergy

Question:

4/15/2019
I have a patient who reports a recent reaction to acetaminophen (Tylenol). She developed marked throat itching and coughing which occurred about 30 minutes after ingestion. No hives, angioedema or other symptoms. No other contributing factors recalled. She has tolerated naproxen and ibuprofen since then. I explained that currently we did not have validated testing for this drug and recommended avoidance at this time. Are there other recommendations, further work-up or challenges that you would pursue?
 

Answer:

As you stated, there is not a standardized or validated test for evaluating acetaminophen hypersensitivity, although Basophil Activation Testing may be useful in the future. A step-wise controlled oral challenge would be useful. A recent meta-analysis1 reported the prevalence of acetaminophen hypersensitivity reaction among children undergoing oral challenge of 10.1%, which is similar to what we see in penicillin.

1) Gabrielli S, Langlois A, Ben-Shoshan M. Prevalence of Hypersensitivity Reactions in Children Associated with Acetaminophen: A Systematic Review and Meta-Analysis. Int Arch Allergy Immunol. 2018;176(2):106-114.

Respectfully submitted.
Jeffrey Demain, MD, FAAAAI