title: A case of severe NSAID exacerbated respiratory disease (NERD) following a dental procedure in a child.
abstract: BACKGROUND
  An allergic reaction following a dental procedure is a rare event. A local anaesthetic (LA) may initially be suspected as a causative agent but allergy to dental LA solutions is extremely rare.
  
  
  METHODS
  This report concerns a 13 year old child who underwent dental treatment and was exposed to Lignospan Special(®) LA, mouthwash, latex gloves, ibuprofen medication, and a Magnum(®) (almond) ice cream all within 45 min. He subsequently developed acute symptoms of nasal rhinorrhoea, facial flushing, peri-orbital and lip angioedema, followed by throat tightness and wheeze (respiratory compromise). His acute reaction was treated by his medical practitioner with oral anti-histamines, steroid and nebulised salbutamol. The child was referred to a local allergist. The child underwent detailed allergic investigations including skin prick tests, blood tests, incremental local anaesthetic challenge and ibuprofen challenge. The patient was diagnosed with NSAID exacerbated respiratory disease (NERD), a hypersensitivity reaction to ibuprofen.
  
  
  RESULTS
  The patient was advised to avoid NSAIDs and to wear a medic-alert (allergy) bracelet. A detailed written report was sent to the patient's dentist and GP.
  
  
  CONCLUSIONS
  In the context of a suspected reaction post dental procedure, local anaesthetic should be considered a possible allergen but other important considerations include analgesics, antibiotics, and latex. All genuine allergic reactions need to be investigated. This report highlights NERD as a possible adverse outcome following dental treatment.
authors.affiliation: Our Lady's Children's Hospital Crumlin, Dublin 12, Ireland. grahampaulking@hotmail.com.
authors.forename: G
authors.initials: G
authors.lastname: King
authors.affiliation: Our Lady's Children's Hospital Crumlin, Dublin 12, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Byrne
authors.affiliation: Our Lady's Children's Hospital Crumlin, Dublin 12, Ireland.|Dublin Dental University Hospital, Trinity College, Dublin 2, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Fleming
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001249:Asthma / Q000150:complications; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000209:etiology*; D004417:Dyspnea / Q000139:chemically induced; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects*; D008012:Lidocaine / Q000009:adverse effects*; D008297:Male; D012135:Respiratory Sounds / Q000209:etiology*; D014081:Tooth Extraction
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D008012:Lidocaine; D007052:Ibuprofen
keywords: Adverse drug reaction; Allergy; Hypersensitivity; Local anaesthetic; NERD; Non-steroidal anti-inflammatory drug (NSAID)