pyrazolone and Anaphylaxis

Topics: Agranulocytosis; Anaphylaxis; Anti-Inflammatory Agents, Non-Steroidal; Drug Eruptions; Drug Hypersensitivity; Humans; Pyrazoles; Pyrazolones

In sensitive patients pyrazolone drugs can precipitate adverse reactions ranging from urticaria and angioedema to anaphylactic shock, presumably by immunological, IgE-mediated mechanism. However, up to now no genetic factors influencing the development of allergic reaction have been reported in this type of hypersensitivity.. The aim of our study was the investigation whether the susceptibility to development of pyrazolone drugs hypersensitivity (PDH) reactions was associated with HLA class II antigens.. To test this hypothesis we studied the distribution of HLA-DR and DQ antigens in 26 pyrazolone sensitive patients and control groups including unselected general population and clearly defined atopic and non-atopic groups.. Significantly higher frequencies of DQ 7 and DR11 antigens were found in PDH group as compared with control unselected population (RR= 16.48, P < 0.0001; P(cor)< 0.002 and RR = 4.57, P = 0.0002; Pcor = 0.003 for DQ and DR antigen respectively). Similarly, statistically significant increased frequencies of DQ 7 and DR11 in patients with PDH were observed compared with atopic control group (RR= 18.43, P < 0.0001; Pcor <0.002 and RR= 6.33, P= 0.0007; Pcor =0.01, for DQ and DR antigen respectively). However, in comparison to non-atopic control group only the frequency of DQ 7 antigen was significantly increased (RR = 15.42, P = 0.0001; Pcor = 0.0015). DQ 7 antigen was present in 46.1% of PDH patients compared with 4.9%, 4.4% and 5.3% in the general population, atopic and non-atopic groups respectively, suggesting pyrazolone hypersensitivity as a trait positively correlated with this HLA antigen.. Our data suggest a genetic predisposition to pyrazolone hypersensitivity reactions, linked to HLA-DQ locus.

Topics: Adolescent; Adult; Anaphylaxis; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Cytotoxicity Tests, Immunologic; Drug Hypersensitivity; Female; HLA-DQ Antigens; HLA-DR Antigens; Humans; Male; Middle Aged; Pyrazoles; Pyrazolones; Urticaria

In 282 patients presenting with adverse reactions to mild analgesics, prick tests were performed with components of analgesic drugs; in some of them, commercial preparations were also tested. In 19 patients (7%), a total of 40 conclusively positive immediate reactions was found: there were 22 reactions to pyrazolone derivatives, 14 reactions to commercial preparations, and one singular reaction to phenacetin, phenobarbital, carbromal and vitamin B1, respectively. Cross-sensitivity to different pyrazolone derivatives was observed in only 5 of 15 patients with a positive reaction to at least one of these substances. One of the patients with a positive immediate reaction and 2 further individuals developed positive test reactions after 4 to 24 h. Within 117 patients who gave a clear-cut history of anaphylactoid reactions to mild analgesics, there were conclusive immediate prick test results in 15 cases (13%). In these patients, the diagnostic relevance of the prick test increased with the severity of symptoms in the history, and a conclusive immediate reaction was obtained in 25% of those with full shock in the history.

Topics: Adolescent; Adult; Aged; Aminophenols; Analgesics; Anaphylaxis; Child; Drug Eruptions; Female; Humans; Hypersensitivity, Immediate; Intradermal Tests; Male; Middle Aged; Pyrazoles; Pyrazolones; Salicylates; Skin Tests

About one third of patients with anaphylactic reactions to pyrazolones showed contact urticaria induced by to at least one pyrazolone after 30-60 min in patch test. This reaction was never observed in patients with various exanthemas or allergic contact dermatitis to these medicaments. Contact urticaria in patch test was mostly caused by propyphenazone, aminophenazone, and metamizole. The suspicious pyrazolone provoked positive results in only about 70%. No correlation could be found between contact urticaria in patch test and severity of allergic history, short interval before skin test and atopic constitution.

Topics: Adolescent; Adult; Aged; Anaphylaxis; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Patch Tests; Pyrazoles; Pyrazolones; Skin Tests; Urticaria