title: Failure of zafirlukast to prevent ibuprofen-induced anaphylaxis.
abstract: 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.
authors.affiliation: Allergy & Asthma Center of El Paso PA, TX 79925, USA.
authors.forename: R
authors.initials: R
authors.lastname: Menendez
authors.forename: J
authors.initials: J
authors.lastname: Venzor
authors.forename: G
authors.initials: G
authors.lastname: Ortiz
mesh_terms: 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*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007211:Indoles; D020024:Leukotriene Antagonists; D048448:Phenylcarbamates; D013449:Sulfonamides; D014105:Tosyl Compounds; D007052:Ibuprofen; C062735:zafirlukast