Prevalence of cross-sensitivity with acetaminophen in aspirin-sensitive asthmatic subjects,☆☆,

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Abstract

Objective: Cross-sensitivity between aspirin and acetaminophen in aspirin-sensitive asthmatic patients has been reported with frequencies ranging from 0% to 29%. The relationship is dose-dependent for acetaminophen challenges, ranging between 300 and 1000 mg. Methods: To determine the prevalence of cross-sensitivity to high-dose acetaminophen, we performed single-blind acetaminophen oral challenges with 1000 mg and 1500 mg in 50 aspirin-sensitive asthmatic patients and in 20 non-aspirin-sensitive asthmatic control subjects. Results: Overall, 17 of 50 (34%) of aspirin-sensitive asthmatic patients reacted to acetaminophen in doses of 1000 to 1500 mg (95% confidence interval: 20% to 49%). By contrast, none of the 20 non-aspirin-sensitive asthmatic patients reacted to acetaminophen (95% confidence interval: 0% to 14%). This difference was highly significant (p = 0.0013), supporting the hypothesis that cross-sensitivity between aspirin and acetaminophen is unique in aspirin-sensitive asthmatic patients. Conclusion: Although high-dose (>1000 mg) acetaminophen cross-reactions with aspirin were significant with respect to frequency (34%), such reactions included easily reversed bronchospasm in only 22%, and were generally mild. We recommend that high doses of acetaminophen (1000 mg or greater) should be avoided in aspirin-sensitive asthmatic patients. (J Allergy Clin Immunol 1995;96:480-5.)

Section snippets

Subjects

Seventy aspirin-sensitive adult asthmatic patients comprised the study population. Patients selected for acetaminophen challenge were those who came to Scripps Clinic and Research Foundation for evaluation and treatment of possible aspirin-sensitive respiratory disease. All 70 patients had a history compatible with aspirin-induced bronchospasm. In 50 patients (group 1), aspirin sensitivity was documented by means of oral aspirin challenges.6 Group 2 consisted of 20 asthmatic patients who,

RESULTS

Challenge results for both group 1 and group 2 patients are shown in Table II. Group 1 asthmatic patients, when challenged with aspirin in doses of 30, 60, and 100 mg, experienced the usual spectrum of responses, with 16 patients experiencing naso-ocular reactions without bronchospasm and 34 experiencing bronchospastic reactions. Group 2 patients did not react to aspirin. Within the subcategories of positive reactions to aspirin, acetaminophen cross-reactions are noted, with a clustering of

DISCUSSION

Delaney4 and Falliers5 reported conflicting data regarding the prevalence of acetaminophen cross-sensitivity in the aspirin-sensitive asthmatic subjects who were challenged with acetaminophen. In both studies patients were challenged with 1000 mg of acetaminophen. Delaney4 reported a cross-sensitivity of 29% (12 of 42), as opposed to the 0% (0 of 15) prevalence reported by Falliers.5

Overestimation bias in the study by Delaney4 might have resulted from several aspects of the design. The criteria

Acknowledgements

We gratefully acknowledge the efforts of the research nurses in the General Clinical Research Center at Scripps Clinic and Research Foundation as well as James A. Koziol, biostatistician for the General Clinical Research Center. The invaluable assistance of Mrs. Jeanine Anderson in the preparation of this manuscript is also acknowledged.

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From the Division of Allergy and Immunology, Scripps Clinic and Research Foundation, La Jolla.

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Supported by General Clinical Research Center grant M01RR-00833, by a Scripps Clinic and Research Foundation grant, and by National Institutes of Health Allergy Disease Center grant AI-10386.

Reprint requests: D.D. Stevenson MD, Division of Allergy and Immunology, Scripps Clinic and Research Foundation, 10666 North Torrey Pines Rd., La Jolla, CA 92037.

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