ABSTRACT
A 38-year-old male sustained sequential anaphylactoid reactions to tolmetin and zomepirac. This is the first report involving these closely related non-steroidal anti-inflammatory drugs (NSAID) in a single patient. He was historically tolerant of other NSAID and tolerated a graded oral aspirin challenge (up to 625 mg) without reaction. Skin testing with aqueous albumin extracts of tolmetin and zomepirac was negative. These reactions appear to differ from previously described aspirin (NSAID) sensitivity. Physicians should beware of interrupted treatment with either of these preparations.
Subject(s)
Anaphylaxis/chemically induced , Pyrroles/adverse effects , Tolmetin/adverse effects , Adult , Humans , Male , Respiratory Function Tests , Skin Tests , Structure-Activity Relationship , Time Factors , Tolmetin/analogs & derivativesABSTRACT
Anaphylaxis to known allergens occurred in two patients under treatment for hypertension with propranolol. The clinical course of both cases was similar. Bradycardia associated with an undetectable blood pressure, unusual severity, and sluggish response to treatment were major common factors in which blockade of the beta-adrenergic system may have had a role. Propranolol, a beta-adrenergic antagonist that acts competitively by blocking the adenylate cyclase receptor on efferent cells, is well recognized to cause increased airways resistance in some asthmatic and normal subjects. It is postulated that propranolol potentiated anaphylaxis in these patients by inhibition of adenylate cyclase, resulting in lowered intracellular cyclic AMP and a lowered threshold of mediator release. The bradycardia during profound hypotension is attributed to an unopposed cholinergic action caused by blunting of the normal endogenous beta-adrenergic response by propranolol.
