Failure of zafirlukast to prevent ibuprofen-induced anaphylaxis.
BACKGROUND
Anaphylaxis to nonsteroidal anti-inflammatory drugs is thought to depend on cycloxygenase inhibition coupled to upregulation of 5-lipoxygenase-dependent pathways. The introduction of leukotriene-receptor antagonists afforded the opportunity to test this hypothesis. These agents provide at least partial protection against aspirin-induced anaphylaxis during controlled challenges but we did not know whether the level of protection was high enough to block symptoms from ingestion of a full dose of aspirin.


METHODS
We report a patient with moderately severe asthma who experienced an episode of anaphylaxis following ingestion of 400 mg of ibuprofen while under therapy with 20 mg of zafirlukast given twice a day.


RESULTS
No further episodes of anaphylaxis have been noted following institution of complete avoidance to all nonsteroidal anti-inflammatory drugs.


CONCLUSIONS
Patients who are sensitive to cycloxygenase inhibitors should practice complete avoidance of these drugs even while under therapy with leukotriene modifiers.
Menendez
R
R
Allergy & Asthma Center of El Paso PA, TX 79925, USA.
Venzor
J
J
Ortiz
G
G
D000293:Adolescent; D000707:Anaphylaxis / Q000517:prevention & control*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects*; D007211:Indoles; D020024:Leukotriene Antagonists; D008297:Male; D048448:Phenylcarbamates; D013449:Sulfonamides; D014105:Tosyl Compounds / Q000627:therapeutic use*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007211:Indoles; D020024:Leukotriene Antagonists; D048448:Phenylcarbamates; D013449:Sulfonamides; D014105:Tosyl Compounds; D007052:Ibuprofen; C062735:zafirlukast