BACKGROUND: Mechanisms responsible for anaphylactoid reactions to N-acetylcysteine (NAC) are poorly understood, and acetaminophen itself may play an important role. The present study examined the relationship between serum acetaminophen concentrations and risk of anaphylactoid reactions. METHODS: Prospective study of adverse reactions to NAC administered according to standardized clinical protocols in patients who present to hospital after acute acetaminophen overdose. Subgroups were defined by serum acetaminophen concentrations 0 to 100 mg/L, 101 to 150 mg/L, 151 to 200 mg/L, 201 to 300 mg/L, and >300 mg/L. RESULTS: There were 362 patients, and anaphylactoid reactions occurred in 14.9%. Anaphylactoid reactions occurred less commonly in patients with high serum acetaminophen concentrations (p = 0.046 by Cochran-Armitage trend test) and high equivalent 4 h acetaminophen concentrations (p = 0.004). DISCUSSION: High serum acetaminophen concentrations were associated with fewer anaphylactoid reactions, suggesting that these might in some way be protective. The biological basis needs further exploration so as to allow a better understanding of the mechanisms responsible for adverse reactions to NAC treatment.
BACKGROUND: Mechanisms responsible for anaphylactoid reactions to N-acetylcysteine (NAC) are poorly understood, and acetaminophen itself may play an important role. The present study examined the relationship between serum acetaminophen concentrations and risk of anaphylactoid reactions. METHODS: Prospective study of adverse reactions to NAC administered according to standardized clinical protocols in patients who present to hospital after acute acetaminophenoverdose. Subgroups were defined by serum acetaminophen concentrations 0 to 100 mg/L, 101 to 150 mg/L, 151 to 200 mg/L, 201 to 300 mg/L, and >300 mg/L. RESULTS: There were 362 patients, and anaphylactoid reactions occurred in 14.9%. Anaphylactoid reactions occurred less commonly in patients with high serum acetaminophen concentrations (p = 0.046 by Cochran-Armitage trend test) and high equivalent 4 h acetaminophen concentrations (p = 0.004). DISCUSSION: High serum acetaminophen concentrations were associated with fewer anaphylactoid reactions, suggesting that these might in some way be protective. The biological basis needs further exploration so as to allow a better understanding of the mechanisms responsible for adverse reactions to NAC treatment.
Authors: Vikhyat S Bebarta; Louise Kao; Blake Froberg; Richard F Clark; Eric Lavonas; Ming Qi; Joao Delgado; John McDonagh; Tom Arnold; Oladapo Odujebe; Gerry O'Malley; Claudia Lares; Elizabeth Aguilera; Richard Dart; Kennon Heard; Chriss Stanford; Jamie Kokko; Greg Bogdan; Carrie Mendoza; Sara Mlynarchek; Sean Rhyee; Jason Hoppe; William Haur; Hock Heng Tan; Nguyen Nguyen Tran; Shawn Varney; Amy Zosel; Jennifer Buchanan; Mohammed Al-Helial Journal: Clin Toxicol (Phila) Date: 2010-06 Impact factor: 4.467
Authors: Mark Yarema; Puja Chopra; Marco L A Sivilotti; David Johnson; Alberto Nettel-Aguirre; Benoit Bailey; Charlemaigne Victorino; Sophie Gosselin; Roy Purssell; Margaret Thompson; Daniel Spyker; Barry Rumack Journal: J Med Toxicol Date: 2018-02-08
Authors: George P Bailey; David M Wood; John R H Archer; Edmund Rab; Robert J Flanagan; Paul I Dargan Journal: Br J Clin Pharmacol Date: 2016-09-29 Impact factor: 4.335
Authors: Euan A Sandilands; Jane Crowe; Hayley Cuthbert; Paul J Jenkins; Neil R Johnston; Michael Eddleston; D Nicholas Bateman; David J Webb Journal: Br J Clin Pharmacol Date: 2013-11 Impact factor: 4.335