Drug intolerance, analgesic-induced T88.7

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Analgesic intolerance; Intolerance to painkillers

Definition
This section has been translated automatically.

Intolerance reactions due to analgesics, especially non-steroidal anti-inflammatory drugs. Aspirin triggers 3/4 of analgesic intolerance. For acetylsalicylic acid, sophisticated allergological test methods are available (inhalative, intranasal, oral). Other agents are frequently prescribed, but the test procedures are not standardised.
  • Scratch test: Production of a saturated suspension with 0.9% NaCl from the pure substances. Scarification of an area measuring 2 × 2 cm using a scalpel on the inside of the forearm. Application of the suspension for 20 minutes. Positive reactions show an increased urticarial component compared to pure 0.9% NaCl solution. Positive control with histamine hydrochloride 0.1% in 0.9% NaCl solution.
  • Severe symptoms of intolerance are distributed per drug as follows:
    • Metamizole (no anaphylactoid reaction)
    • carbamazepine (no anaphylactoid reaction, only cutaneous symptoms, of which 50% are erythema exsudativa multiforme)
    • Propyphenazone (30% anaphylactoid reactions, bronchial reactions)
    • Diclofenac
    • Ibuprofen: cutaneous symptoms (exanthema, urticaria, quincke oedema).

Tables
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Positive test results in case of a suspected analgesic intolerance (n = 98).

Active substance

scratch test positive

Exposure test positive

Propyphenazone

2

25

Diclofenac

0

12

Metamizole

1

5

Ibuprofen

0

6

Carbamazepine

0

4

Indomethacin

0

2

Phenazone

0

1

Paracetamol

0

1


Dosage regimen for exposure testing for analgesic intolerance

Active substance

Single dose (mg)

Propyphenazone

2

5

10

25

50

100

Diclofenac

5

10

25

50

100

Metamizole

5

10

25

50

100

Ibuprofen

5

10

25

50

100

250

Carbamazepine

100

200

300

Literature
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  1. Ahlbach S et al (2003) The selective cyclooxygenase-2 inhibitor celecoxib is a safe alternative in patients with pseudo-allergic reactions to nonsteroidal anti-inflammatory drugs. Med Klin (Munich) 98: 242-244
  2. Erdmann S et al (2003) Intolerance reactions. Dtsch Med Weekly 128: 1715-1720
  3. Gosepath J et al (2002) Aspirin sensitivity: long term follow-up after up to 3 years of adaptive desensitization using a maintenance dose of 100 mg of aspirin a day. Laryngorhinootology 81: 732-738
  4. Wiedow O et al (1996) Oral exposure tests for non-aspirin related analgesic intolerance. dermatologist 47: 901-908

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020