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Non allergic angioedema: case report A 42 year-old woman developed non allergic angioedema during treatment with diclofenac, nimesulide, ibuprofen for back pain. Additionally, she developed the same reaction following oral drug challenge test with ketorolac [dosages not stated]. The woman, presented with back pain form 4 years. She had been receiving unspecified ayurvedic medications and massage therapy for her back pain. Then, she discontinued her unspecified ayurvedic medications a month prior to opting allopathy. Thereafter, she was prescribed diclofenac. However, after diclofenac initiation, she developed angioedema without urticaria, which was unusual. Therefore, she was prescribed with other NSAIDs like ibuprofen and nimesulide for which, she again developed the same reaction. She had developed three episodes of drug-induced reaction in a month, which was always at least 10 hours after the drug ingestion (diclofenac, ibuprofen and nimesulide), which was unusual. She was suspected to have a drug allergy to NSAIDs. Thus, to confirm if she had drug allergy to NSAIDs skin prick test was done for diclofenac 0.2 mg/mL and paracetamol 0.5 mg/mL concentrations which turned negative, followed by intradermal test for diclofenac 22.5 mg/mL which was also negative. To confirm drug allergy oral drug challenge test was done using sublingual ketorolac 10mg. However, she could not tolerate 50% of ketorolac 10mg. After 9 hours, she complained about throat irritation without skin rashes; non allergic angioedema was suspected. The woman was treated with pheniramine and betamethasone injections to subside the reaction. But, she had minimal response to pheniramine and betamethasone. Thus, non-allergic angioedema due to NSAIDs was suspected. Eventually, based on the clinical response and observations the reaction was confirmed to be NSAIDs induced non-allergic angioedema. Chinju, et al. Ketorolac induced non allergic angioedema: A case report. International Journal of Research in Pharmaceutical Sciences 11: 4342-4346, No. 3, 9 Jul 2020. Available from: URL: http://doi.org/10.26452/ijrps.v11i3.2650 803499431

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