[Severe allergic reaction due to a rectal enema]

Allergic drug reactions must always be considered when prescribing treatment, even in frequent pediatric problems such as acute abdominal pain due to constipation. We describe an original case of anaphylactic shock due to the administration of hypertonic rectal enema in a child. A 9-year-old child admitted to the emergency department for an acute complaint of abdominal pain related to constipation received an administration of a hypertonic rectal enema to allow the passage of stools. Afterwards, the child presented a life-threatening episode, requiring emergency treatment with transfer to the pediatric intensive care unit, suggesting an anaphylactic shock. The absence of any other drug or food intake, the chronology of events, and favorable outcome after treatment led to the diagnosis of a probable allergy to methylparaben, sodium parahydroxybenzoate, present as the excipient in the rectal enema. Anaphylactic shock is a serious allergic reaction, setting in rapidly, which may lead to fatal outcome. Most reactions to parabens reported concern, almost exclusively, the cutaneous application of paraben-containing topical preparations. The present observation underscores the original and undescribed risk of an allergic general reaction following the rectal administration of parabens. The indications of any prescription must be carefully observed and potential drug contraindications, considering the patient's history of allergy, should be sought.