Prevalence of cross-sensitivity with acetaminophen in aspirin-sensitive asthmatic subjects.
OBJECTIVE
Cross-sensitivity between aspirin and acetaminophen in aspirin-sensitive asthmatic patients has been reported with frequencies ranging from 0% to 29%. The relationship is dose-dependent for acetaminophen challenges, ranging between 300 and 100 mg.


METHODS
To determine the prevalence of cross-sensitivity to high-dose acetaminophen, we performed single-blind acetaminophen oral challenges with 1000 mg and 1500 mg in 50 aspirin-sensitive asthmatic patients and in 20 non-aspirin-sensitive asthmatic control subjects.


RESULTS
Overall, 17 of 50 (34%) of aspirin-sensitive asthmatic patients reacted to acetaminophen in doses of 1000 to 1500 mg (95% confidence interval: 20% to 49%). By contrast, none of the 20 non-aspirin-sensitive asthmatic patients reacted to acetaminophen (95% confidence interval: 0% to 14%). This difference was highly significant (p = 0.0013), supporting the hypothesis that cross-sensitivity between aspirin and acetaminophen is unique in aspirin-sensitive asthmatic patients.


CONCLUSIONS
Although high-dose ( > 1000 mg) acetaminophen cross-reactions with aspirin were significant with respect to frequency (34%), such reactions included easily reversed bronchospasm in only 22%, and were generally mild. We recommended that high doses of acetaminophen (1000 mg or greater) should be avoided in aspirin-sensitive asthmatic patients.
Settipane
R A
RA
Division of Allergy and Immunology, Scripps Clinic and Research Foundation, La Jolla, CA 92037, USA.
Schrank
P J
PJ
Simon
R A
RA
Mathison
D A
DA
Christiansen
S C
SC
Stevenson
D D
DD
D000082:Acetaminophen / Q000276:immunology* / Q000494:pharmacology; D000328:Adult; D000368:Aged; D001241:Aspirin / Q000276:immunology* / Q000494:pharmacology; D001249:Asthma / Q000150:complications / Q000276:immunology*; D003429:Cross Reactions; D004306:Dose-Response Relationship, Immunologic; D004342:Drug Hypersensitivity / Q000150:complications / Q000453:epidemiology / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D016037:Single-Blind Method
D000082:Acetaminophen; D001241:Aspirin