title: Anaphylaxis following intravenous paracetamol: the problem is the solution.
abstract: Paracetamol is a ubiquitous analgesic and antipyretic that is widely administered, including by anaesthetists. Immediate hypersensitivity reactions to intravenous paracetamol are particularly rare. We report two cases involving four separate episodes of anaphylaxis to intravenous paracetamol in different perioperative settings without a past history of intolerance to the oral form. The allergological investigations are described, during which it became evident that both patients were allergic to an excipient (mannitol) present in the formulation and that neither was allergic to the principal agent (paracetamol). The importance of referral and investigation of perioperative drug reactions is underscored by these two cases.
authors.affiliation: Anaesthetic Allergy Clinic, Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St Leonards, New South Wales.
authors.forename: S S
authors.initials: SS
authors.lastname: Jain
authors.affiliation: Anaesthetic Allergy Clinic, Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St Leonards, New South Wales.
authors.forename: S
authors.initials: S
authors.lastname: Green
authors.affiliation: Anaesthetic Allergy Clinic, Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St Leonards, New South Wales.
authors.forename: M
authors.initials: M
authors.lastname: Rose
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000707:Anaphylaxis / Q000139:chemically induced*; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
keywords: acetaminophen [paracetamol]; anaphylaxis; excipient; mannitol; pharmaceutical solutions