sulindac and Anaphylaxis

We present a case of a severe reaction to sulindac. A 30-year-old woman with quiescent systemic lupus erythematosus received sulindac for nonspecific migrating chest pain. An initial course of therapy produced an unrecognized sensitization to the drug with a febrile illness and rash. Readministration of the drug caused an anaphylactoid reaction as well as evidence of cardiovascular, hepatic, pulmonary, and hematologic dysfunction. The patient's illness had evidence of types I, II, and III hypersensitivity reactions.

Topics: Adult; Anaphylaxis; Chest Pain; Drug Hypersensitivity; Female; Humans; Lupus Erythematosus, Systemic; Sulindac

The nonsteroidal anti-inflammatory drugs are widely used in the United States and are a frequent cause of cutaneous reactions. Since December 1980, dermatologists have reported 135 of these drug reactions to a specialty-based Adverse Drug Reaction Reporting System. Reactions to piroxicam were most frequently reported; the majority of reactions to this drug were vesiculobullous and occurred most often in sun-exposed areas. Other reactions to nonsteroidal anti-inflammatory drugs not previously recognized include serum sickness, exfoliative erythroderma, and photosensitivity associated with sulindac; toxic epidermal necrolysis was reported with tolmetin, zomepirac sodium, and piroxicam. Fixed drug eruptions were noted with ibuprofen and naproxen, and photosensitivity was reported with sulindac and indomethacin. These findings illustrate the usefulness of a specialty-based system for spontaneous reporting of new and serious adverse reactions to drugs.

Topics: Aged; Anaphylaxis; Anti-Inflammatory Agents; Drug Eruptions; Drug Hypersensitivity; Female; Humans; Meclofenamic Acid; Photosensitivity Disorders; Piroxicam; Propionates; Stevens-Johnson Syndrome; Sulindac; Thiazines; Tolmetin

Reported is the case of an anaphylactic reaction following sulindac ingestion. A 64-year-old man developed marked shortness of breath following the ingestion of a 200-mg sulindac tablet. On admission he had a palpable blood pressure of 50 mm Hg and diffuse inspiratory and expiratory wheezes on auscultation. He demonstrated marked cardiovascular instability for 24 hours following the adverse reaction. He was treated successfully with a continuous intravenous infusion of epinephrine, a corticosteroid, and an antihistamine. Recovery was complete. This case demonstrates that caution is needed in prescribing sulindac and other nonsteroidal anti-inflammatory drugs.

Topics: Anaphylaxis; Drug Hypersensitivity; Electrocardiography; Emergencies; Epinephrine; Humans; Hypotension; Indenes; Male; Middle Aged; Sulindac

This communication describes the first known report of sulindac-induced anaphylaxis. A 17-year-old patient who ingested a single tablet of sulindac developed pruritus, hives, and dyspnea. Blood pressure was not detectable. The patient was treated with epinephrine, a corticosteroid, and an antihistamine. Recovery was complete. The ability of this class of drugs to produce dangerous reactions is discussed.

Topics: Adult; Anaphylaxis; Arthritis, Juvenile; Drug Hypersensitivity; Female; Humans; Indenes; Sulindac