Drug intolerance, analgesic-inducedT88.7
Synonym(s)
Analgesic intolerance; Intolerance to painkillers
DefinitionThis 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).
TablesThis section has been translated automatically.
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 |
|||
LiteratureThis section has been translated automatically.
- 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
- Erdmann S et al (2003) Intolerance reactions. Dtsch Med Weekly 128: 1715-1720
- 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
- Wiedow O et al (1996) Oral exposure tests for non-aspirin related analgesic intolerance. dermatologist 47: 901-908