RESUMO
An 18-year-old female hairdresser, nonsmoker and nonatopic, developed rhinoconjunctivitis followed by asthma after working for 18 months. The methods that were necessary to obtain a definitive diagnosis of occupational asthma are explained, as well as the medical management performed to improve her asthma over the next 12 months. Tryptase and eosinophil cationic protein (ECP) were determined before and after specific bronchial challenge. The application of these parameters as complementary diagnostic methods in some cases of occupational asthma is described. Clinical and functional control performed some months later demonstrated an increase in nonspecific bronchial responsiveness after avoidance, likely related to an upper respiratory infection.
Assuntos
Asma/diagnóstico , Barbearia , Tinturas para Cabelo/efeitos adversos , Doenças Profissionais/diagnóstico , Exposição Ocupacional , Adolescente , Asma/etiologia , Asma/terapia , Testes de Provocação Brônquica , Dermatite de Contato/diagnóstico , Dermatite de Contato/etiologia , Dermatite de Contato/terapia , Feminino , Humanos , Hipersensibilidade Imediata/diagnóstico , Hipersensibilidade Imediata/etiologia , Hipersensibilidade Imediata/terapia , Doenças Profissionais/etiologia , Doenças Profissionais/terapia , Fenilenodiaminas/efeitos adversos , Sulfatos/efeitos adversosRESUMO
BACKGROUND: Acetaminophen (paracetamol) is an analgesic antipyretic drug with no antiinflammatory effects and is widely used worldwide. Earlier clinical studies reported IgE-mediated adverse reactions to acetaminophen, but in vivo and in vitro tests have been inconclusive. OBJECTIVE: We propose to demonstrate an IgE-mediated mechanism in four patients with adverse reactions to acetaminophen (paracetamol). Tolerance to aspirin and other nonsteroidal antiinflammatory drugs are present in all patients. METHODS: We studied four patients with anaphylactic reactions to acetaminophen who tolerated aspirin and other nonsteroidal antiinflammatory drugs. Skin tests, oral challenges and immunoassay for allergen-specific IgE antibodies with acetaminophen were performed in all patients. RESULTS: All patients tolerated the aspirin oral challenge without adverse effects. In contrast, the oral challenge with acetaminophen produced adverse effects in all patients. Skin tests with acetaminophen were positive in two patients (3-mm wheal and flare) and IgE antibodies acetaminophen were detected in serum from two patients. CONCLUSION: We describe four patients with adverse reactions to acetaminophen but with tolerance to aspirin and other nonsteroidal antiinflammatory drugs. Skin tests, oral challenges, and serum IgE results with acetaminophen suggest that an IgE-mediated mechanism is responsible for these reactions.
