Anaphylactoid reactions to tolmetin and zomepirac

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.