title: Fatal hypersensitivity reaction to an oral spray of flurbiprofen: a case report.
abstract: OBJECTIVE
  Safety of the anti-inflammatory drug flurbiprofen is comparable with that of other non-steroidal anti-inflammatory drugs of the propionic acid class, which are commonly associated with gastrointestinal and renal side effects. Here we report a case of a fatal hypersensitivity reaction to an oral spray of flurbiprofen taken for sore throat.
  
  
  METHODS
  A 29-year-old man came to the emergency care unit reporting sore throat with an intense burning sensation associated with fever. Pharyngotonsillitis was diagnosed, and local treatment with oral flurbiprofen spray was prescribed. Immediately after using the spray, the patient experienced a severe reaction characterized by serious dyspnoea, followed by death. The cause of death was heart failure with acute asphyxia from oedema of the glottis. The cause of death was concluded to be hypersensitivity to flurbiprofen spray.
  
  
  CONCLUSIONS
  Oral propionic acid derivatives have been associated with a relatively high frequency of allergic reactions. However, allergy to flurbiprofen has rarely been documented. Scientific literature reports two relevant cases of hypersensitivity reaction to flurbiprofen: in one case, a patient presented with a maculopapular rash 48 h after having taken oral flurbiprofen followed by angio-oedema and hypotension. In another case, a single oral dose of flurbiprofen caused itching and swelling around the eyes, redness and increased lacrimation. We describe, for the first time, a fatal case of hypersensitivity reaction to flurbiprofen oral spray. Hypersensitivity reactions to flurbiprofen are infrequent; however, health professionals should be aware of potential adverse reactions, even during topical administration as oral spray.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. gcalapai@unime.it
authors.forename: G
authors.initials: G
authors.lastname: Calapai
authors.forename: S
authors.initials: S
authors.lastname: Imbesi
authors.forename: V
authors.initials: V
authors.lastname: Cafeo
authors.forename: E
authors.initials: E
authors.lastname: Ventura Spagnolo
authors.forename: P L
authors.initials: PL
authors.lastname: Minciullo
authors.forename: A P
authors.initials: AP
authors.lastname: Caputi
authors.forename: S
authors.initials: S
authors.lastname: Gangemi
authors.forename: L
authors.initials: L
authors.lastname: Milone
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000209:etiology*; D005480:Flurbiprofen / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D008297:Male; D058993:Oral Sprays; D010612:Pharyngitis / Q000188:drug therapy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D058993:Oral Sprays; D005480:Flurbiprofen
keywords: NSAID; adverse Effect; adverse reaction; anti inflammatory; fatal reaction; flurbiprofen; hypersensitivity; pharmacovigilance; spray