Lower incidence of anaphylactoid reactions to N-acetylcysteine in patients with high acetaminophen concentrations after overdose
Lower incidence of anaphylactoid reactions to N-acetylcysteine in patients with high acetaminophen concentrations after overdose
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DOI：
10.1080/15563650701864760
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发表时间：
2008-01-01
影响因子：
3.3
通讯作者：
Pettie, Janice M.
中科院分区：
文献类型：
--
作者：
Waring, W. Stephen;Stephen, Alexandra F.;Pettie, Janice M.
背景资料。N-乙酰半胱氨酸(NAC)类过敏反应的机制尚不清楚，对乙酰氨基酚本身可能起到重要作用。本研究调查了血清对乙酰氨基酚浓度和类过敏反应风险之间的关系。方法：研究方法。急性对乙酰氨基酚过量给药后住院患者按标准化临床方案服用NAC不良反应的前瞻性研究。血清对乙酰氨基酚浓度分别为0~10 0 mg/L、10 1~15 0 mg/L、15 1~2 0 0 mg/L、2 0 1~30 0 mg/L和30 0 mg/L。362例患者出现类过敏反应，发生率为14.9%。类过敏反应在血清对乙酰氨基酚浓度高(经Cochran-Armitage趋势检验p=0.046)和当量4h对乙酰氨基酚浓度高(p=0.004)的患者中较少发生。讨论。较高的血清对乙酰氨基酚浓度与较少的类过敏反应有关，这表明这些反应可能在某种程度上具有保护作用。生物学基础需要进一步探讨，以便更好地了解NAC治疗不良反应的机制。
Background. Mechanisms responsible for anaphylactoid reactions to N-acetylcysteine (NAC) are poorly understood, and acetaminophen itself may play an important role. The present study examined the relationship between serum acetaminophen concentrations and risk of anaphylactoid reactions. Methods. Prospective study of adverse reactions to NAC administered according to standardized clinical protocols in patients who present to hospital after acute acetaminophen overdose. Subgroups were defined by serum acetaminophen concentrations 0 to 100 mg/L, 101 to 150 mg/L, 151 to 200 mg/L, 201 to 300 mg/L, and >300 mg/L. Results. There were 362 patients, and anaphylactoid reactions occurred in 14.9%. Anaphylactoid reactions occurred less commonly in patients with high serum acetaminophen concentrations (p = 0.046 by Cochran-Armitage trend test) and high equivalent 4 h acetaminophen concentrations (p = 0.004). Discussion. High serum acetaminophen concentrations were associated with fewer anaphylactoid reactions, suggesting that these might in some way be protective. The biological basis needs further exploration so as to allow a better understanding of the mechanisms responsible for adverse reactions to NAC treatment.