Behind the scene: Paracetamol hypersensitivity in children

Area of Science:

• Pediatric Allergy and Immunology
• Pharmacology
• Drug Hypersensitivity

Background:

• Paracetamol is a widely used non-steroidal anti-inflammatory drug for fever and pain.
• Evaluating children with suspected paracetamol hypersensitivity is crucial due to its common use.
• Accurate diagnosis is essential for managing potential adverse reactions.

Purpose of the Study:

• To evaluate children with suspected paracetamol hypersensitivity.
• To confirm diagnoses using objective testing methods.
• To classify reaction types and identify safe alternative medications.

Main Methods:

• Sixty children with suspected paracetamol hypersensitivity underwent evaluation.
• Reactions were classified using established allergy network guidelines.
• Diagnosis was confirmed via skin tests and oral challenge tests (OCTs).
• OCTs with COX-1 and COX-2 inhibitors were used to classify intolerance and find alternatives.

Main Results:

• Hypersensitivity to paracetamol was confirmed in 8 out of 60 children.
• Four children were selective responders, and 3 were cross-intolerant to COX-1 inhibitors.
• Skin tests showed low positivity; OCTs were definitive.
• Safe alternative non-steroidal anti-inflammatory drugs were identified for cross-intolerant patients.

Conclusions:

• Oral challenge testing (OCT) is the gold standard for diagnosing paracetamol-induced hypersensitivity.
• OCTs are vital for classifying reaction types (selective vs. cross-intolerance).
• OCTs successfully identify safe alternative drugs for hypersensitive children.