Cross-reactivity between aspirin and ibuprofen in an asthmatic--a case report

A case of an adverse reaction occurring in a 53-year-old, aspirin-sensitive asthmatic male with nasal polyps following administration of a 400-mg ibuprofen tablet is reported. Symptoms of the adverse reaction included an urticarial rash, labored breathing, laryngeal edema and tightness of the chest. Treatment consisted of isoproterenol inhalant (self-administered), subcutaneous epinephrine 0.25 mg, intramuscular diphenhydramine hydrochloride 50 mg and intravenous hydrocortisone 250 mg. The pathogenesis of the patient's adverse reaction and the possible fole of aspirin, of other analgesics and of tartrazine in its development are discussed. The adverse reaction was not mediated immunologically but rather resulted from the prostaglandin synthetase (PGS)-inhibitor activity shared by aspirin, ibuprofen and other analgesics. Selection of an analgesic for an aspirin-sensitive patient should be based on the analgesic's PGS-inhibitor activity.