Paracetamol
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Delayed-type acute urticaria and angioneuroedema: case report A 4-month-old girl developed delayed-type acute urticaria and angioneuroedema during treatment with paracetamol to prevent fever. The girl was hospitalised in November 2019, due to skin rash for 2 days, aggravated with fever for 1 day. Four days before admission, she had a runny nose. Therefore, a physician was consulted; however, no medicines were prescribed. At the end of the visit, her family treated her with paracetamol dry suspension [acetaminophen; route and dosage not stated] to prevent fever. After 3 days of continuous administration of paracetamol, she developed red macula on the mandible. On day 4 of administration, the rash spread to her face, with accompanying swelling of her hands and feet. She developed a fever. Hence, she was hospitalised for further diagnosis and treatment (current presentation). Subsequent physical examination revealed a red maculopapular rash all over her body, partly in patches, elevated skin temperature, more distribution of rash on the face and extremities with hard oedema of the eye sockets, face, hands and feet. Additionally, she was found to have red lips and slightly congested pharynx. Based on the medical history, clinical symptoms and medication history at the time of admission, she was diagnosed with urticaria with angioneuroedema (angioedema). The clinical pharmacist concluded that it was an acute, delayed reaction to paracetamol. Additionally, the pharmacist recommended that the physician administer anti-allergic medication and advised her family to avoid paracetamol and paracetamolcontaining compound drugs. Based on the Naranjo adverse drug reaction probability score of 6, a causal relation between paracetamol and the delayed-type acute urticaria was assessed as ’probable’. Then, the physician was consulted for treatment. The girl started receiving treatment with calcium gluconate, vitamin C and desloratadine. On day 2 of hospitalisation, she had a fever at night. As a corrective measure, physical cooling methods were used. Her body temperature returned to normal with the cooling methods. The symptoms urticaria, local skin temperature and facial oedema improved. However, rigid oedema on hands and feet did not improve. Then, after the recommendation of clinical pharmacists, her treatment with calcium gluconate and vitamin C was discontinued, and only desloratadine was continued as anti-allergic treatment. On the third day of admission, her body temperature was normal, and the rash improved, with no rigid oedema on the face, hands and feet. On hospital day 5, her general condition was good-without fever, rash and other discomfort. She was discharged. After 3 months, at follow-up, she did not have any symptoms of urticaria or angioneurotic oedema. Liu JB, et al. Acetaminophen induced delayed-type urticaria and angioedema in a child. Zhonghua Er Ke Za Zhi 58: 682-683, No. 8, 2020. Available from: URL: http:// 803505714 doi.org/10.3760/cma.j.cn112140-20200313-00229 [Chinese; summarised from a translation]
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