[Severe allergic reaction due to a rectal enema]

Area of Science:

• Pediatric Allergy
• Pharmacovigilance
• Gastroenterology

Background:

• Allergic drug reactions are critical considerations in pediatric care, even for common issues like constipation.
• Acute abdominal pain in children often necessitates interventions like rectal enemas.

Observation:

• A 9-year-old child developed life-threatening anaphylactic shock post-administration of a hypertonic rectal enema for constipation.
• The patient required pediatric intensive care unit admission and emergency treatment.

Findings:

• Diagnosis pointed to a probable allergy to methylparaben (sodium parahydroxybenzoate), an excipient in the enema.
• This case represents a novel instance of anaphylaxis following rectal paraben exposure, distinct from typical cutaneous reactions.

Implications:

• Clinicians must consider rare allergic reactions to medication excipients, including parabens, via rectal administration.
• Careful review of patient history for allergies and potential drug contraindications is essential before prescribing treatments.