[Anaphylactic reaction to N-acetylcysteine after poisoning with paracetamol]

Paracetamol is among the most common substances consumed in self-poisoning attempts. The recommended treatment is intravenous N-acetylcysteine. Adverse reactions to this treatment are relatively common, but are rarely serious. The article reports and discusses a patient who had an anaphylactoid reaction to N-acetylcysteine after an overdose of paracetamol. This reaction was most probably an acute toxic effect of N-acetylcysteine, and not a result of an immunologic hypersensitivity reaction. Reducing the infusion rate of the initial loading dose might reduce the risk of adverse reactions. Recent guidelines recommend giving the loading dose over 60 minutes, instead of 15 minutes.