Failure of zafirlukast to prevent ibuprofen-induced anaphylaxis.
BACKGROUND: Anaphylaxis to nonsteroidal anti-inflammatory drugs is thought to depend on cycloxygenase inhibition coupled to upregulation of 5-lipoxygenase-dependent pathways. The introduction of leukotriene-receptor antagonists afforded the opportunity to test this hypothesis. These agents provide at least partial protection against aspirin-induced anaphylaxis during controlled challenges but we did not know whether the level of protection was high enough to block symptoms from ingestion of a full dose of aspirin. METHODS: We report a patient with moderately severe asthma who experienced an episode of anaphylaxis following ingestion of 400 mg of ibuprofen while under therapy with 20 mg of zafirlukast given twice a day. RESULTS: No further episodes of anaphylaxis have been noted following institution of complete avoidance to all nonsteroidal anti-inflammatory drugs. CONCLUSIONS: Patients who are sensitive to cycloxygenase inhibitors should practice complete avoidance of these drugs even while under therapy with leukotriene modifiers.[1]References
- Failure of zafirlukast to prevent ibuprofen-induced anaphylaxis. Menendez, R., Venzor, J., Ortiz, G. Ann. Allergy Asthma Immunol. (1998) [Pubmed]
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